The very low levels of adoption of EHRs in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of healthcare performance goals that depend on health IT, according to a survey in the April 16 issue of the New England Journal of Medicine. Ashish K. Jha, MD, and colleagues from the Harvard School of Public Health in Boston, along with the new national heath IT coordinator David Blumenthal, MD, surveyed all acute-care hospitals that are members of the American Hospital Association (AHA) for the presence of specific electronic-record functionalities.

Using a definition of EHRs based on expert consensus, the researchers determined the proportion of hospitals that had such systems in their clinical areas. They also examined the relationship of adoption of EHRs to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption.

On the basis of responses from 63.1 percent of hospitals surveyed, the investigators said that only 1.5 percent of U.S. hospitals have a comprehensive EHR system (i.e., present in all clinical units), and an additional 7.6 percent have a basic system (i.e., present in at least one clinical unit). Computerized provider order entry (CPOE) for medications has been implemented in only 17 percent of hospitals.

Larger hospitals, those located in urban areas and teaching hospitals, were more likely to have EHR systems, according to the researchers. However, respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with EHR systems were less likely to cite the barriers than hospitals without such systems.

The authors said that another potential barrier to adoption is concern about interoperability: "few EHR systems allow for easy exchange of clinical data between hospitals or from hospitals to physicians' offices. Low levels of health information exchange in the marketplace reduce the potential value of these systems and may have a dampening effect on adoption," they wrote.

Jha and colleagues concluded that a policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of EHR systems in U.S. hospitals. Also, they wrote that "rewarding hospitals--especially financially vulnerable ones--for using health IT may play a central role in a comprehensive approach to stimulating the spread of hospital EHR systems. Creating incentives for increasing IT staff and harmonizing IT standards and creating disincentives for not using such technology may also be helpful approaches."