California report does not project high EHR adoption. Source: New York Times

More than three years after President George W. Bush called for all Americans to have EHRs by 2014, a new California HealthCare Foundation (CHCF) report suggests that there has been no measurable increase in health IT adoption.

The CHCF’s report is based on in-depth interviews last summer with nearly two-dozen healthcare, business and government leaders.

To advance the president’s plan, David Brailer, MD, the nation’s first health IT coordinator, pursued a strategy constructed around the proliferation of EHR systems. The strategy included the creation of a National Health Information Technology Network, a Healthcare Information Technology Standards Panel and other projects designed to promote EHR use and adoption.

According to the report, California leads the United States in EHR adoption with 37 percent of physicians reporting use of EHRs, compared with 28 percent nationally. In California, the larger the medical practice, the more likely it uses EHRs. The CHCF said that approximately 79 percent of Kaiser Permanente physicians reported using EHRs, followed by 57 percent of patients in large practices of 10 or more physicians. But EHR usage dropped considerably among small/medium practices (25 percent) and solo practitioners (13 percent), the report said.

Even when physicians have EHRs, they often fail to take advantage of the full capability of the powerful systems, according to the report. The CHCF found that only 12 percent of California physicians use alerts to warn them about potential adverse drug events, receive electronic warnings about abnormal lab results and send reminder notices to patients about regular or preventive follow-up care.

Only 13 percent of hospitals have fully implemented EHRs and only 11 percent are fully using bar-coding technology for the administration of drugs, the report said. “Institutions that lag behind on health IT are likely to continue seeing avoidable treatment errors,” said Jonah Frohlich, CHCF senior program officer.

The major barrier for EHR adoption by medical groups was cost (59 percent), followed by the difficulty and expense of implementation (42 percent); uncertainty about how to select the right product (31 percent); and resistance to changes in practice style (30 percent), according to the report. Among long-term care facilities, the lack of integration with other systems was the most commonly cited barrier to HIT adoption.

The interviewed concluded that the nationwide health information network is impractical and cannot be implemented, and the report notes there’s little support for healthcare IT from Congress. The report also acknowledged difficulty in harmonizing state and federal privacy laws and developing interoperability standards. The report also noted there has been little resolution of the cost barrier for smaller physician practices.