Opportunities and costs
Given the lack of EHR adoption throughout the health care world, there are a lot of opportunities to get this right (or wrong). Less than 10 percent of U.S. hospitals have adopted electronic medical records even in the most basic way, according to a study authored by Ashish Jha, associate professor of health policy and management at Harvard School of Public Health, and published in the April 16 New England Journal of Medicine. Only 1.5 percent have adopted a comprehensive system of electronic records that includes physicians' notes and orders and decision support systems that alert doctors of potential drug interactions or other problems that might result from their intended orders.
Cost is the primary factor stalling EHR systems, followed by resistance from physicians unwilling to adopt new technologies and a lack of staff with adequate IT expertise, according to Jha. He indicated that a hospital could spend from $20 million to $200 million to implement an electronic record system over several years, depending on the size of the hospital. A typical doctor's office would cost an estimated $50,000 to outfit with an EHR system.
The upside of EHR systems is more difficult to quantify. Although some estimates say that hospitals and doctor's offices could save as much as $100 million annually by moving to EHRs, the mere act of implementing the technology guarantees neither cost savings nor improvements in care, Jha said during a Harvard School of Public Health community forum on September 17. Another Harvard study of hospital computerization likewise determined that cutting costs and improving care through health IT as it exists today is "wishful thinking". This study was led by David Himmelstein, associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital in Massachusetts, and published in the November issue of the American Journal of Medicine (pdf).
The cost of getting it wrong
The difference between the projected cost savings and the reality of the situation stems from the fact that the EHR technologies implemented to date have not been designed to save money or improve patient care, says Leonard D'Avolio, associate center director of Biomedical Informatics at the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), located at the VA Boston Healthcare System center in Jamaica Plain. Instead, EHRs are used to document individual patients' conditions, pass this information among clinicians treating those patients, justify financial reimbursement and serve as the legal records of events.
This is because, if a health care facility has $1 million to spend, its managers are more likely to spend it on an expensive piece of lab equipment than on information technology, D'Avolio says, adding that the investment on lab equipment can be made up by charging patients access to it as a billable service. This is not the case for IT. Also, computers and networks used throughout hospitals and health care facilities are disconnected and often manufactured by different vendors without a standardized way of communicating. "Medical data is difficult to standardize because caring for patients is a complex process," he says. "We need to find some way of reaching across not just departments but entire hospitals. If you can't measure something, you can't improve it, and without access to this data, you can't measure it."