A national survey of US doctors shows growth in electronic recordkeeping use, though the full benefits won’t be realized years into the future.
Forty-three percent of American doctors now use an electronic health records (EHR) system, though only a quarter them leverage the data in aggregate for more meaningful assessment of care.
Since 2010, the United States has spent more than $3.9 billion to encourage primary care physicians and specialists to adopt computerized record systems, as the U.S. Centers for Medicare and Medicaid Services pays doctors and hospitals $44,000 to $64,000 for the promise of improving care and eventually saving money.
The rate of adoption of basic electronic recordkeeping rose from early 2011 from one in three doctors to 43.5 percent by last March, according to a national survey of 1,820 physicians published in the Annals of Internal Medicine. “Current evidence suggests that the rate of adoption of basic EHRs has accelerated,” wrote the report’s authors. “However, less is known at a national level about the extent to which physicians are using these systems to manage their patient panels.”
Most commonly, doctors are using electronic records to view laboratory and radiology imaging results, order prescriptions, and record clinical notes in a patient file. But doctors were less likely to use that data to collaborate with outside entities — while adhering to federal patient privacy law — or generate quality metrics for assessment of medical care. They were also less likely to provide patients, in this era of the online autodidact, with post-clinical summaries and copies of health information.
In 2009, the Health Information Technology for Economic and Clinical Health Act authorized the administration to incentivize physicians along an “escalator” of improvements in recordkeeping, pushing them eventually toward a more “meaningful use” of aggregated data. Requirements for the initial phase involve capturing health information in a coded format and then tracking the information to ensure communication among health care providers in managing disease and medications, while reporting clinical quality measures and public health information.
Further up the escalator of improvement, doctors would not merely attest to the government their use of the system but demonstrate how they’re using EHRs to support patient care — for example, using clinical information to identify patients who should receive reminders for preventive or follow-up care.
“Using an HER in a way that may result in higher-quality, more efficient care, however, will probably require physicians to aggregate individual-patient data to enable population assessment and management,” the authors wrote. “This activity requires that clinicians know how to query and analyze data and use the information to change practice.”
Among doctors in the first stage of adoption of electronic recordkeeping, many physicians are not currently meeting “meaningful use” standards set by the government. “Computerized systems for patient panel management and quality reporting do not seem widespread, and where they are implemented, physicians reported that they are not always easy to use,” the authors wrote.
Along with this slower-than-expected leveraging of data are tempered expectations for cost-savings on the national level. While a 2005 Rand Corporation report projected health care savings of $81 billion per year, a new report in January suggested that widespread savings would not be realized anytime soon given the expense of electronic health records and the lack of universal adoption.
Even with financial incentives from the government, costs associated with installation, training, and technology maintenance have led many doctors to delay adoption of the systems — even with the threat of financial penalties for failure to adopt by 2015. Neil Fleming, a researcher at Baylor Health Center, told media that some doctors merely break even on the financial incentives, after paying for technology and training.
“It’s not a plug-and-play situation where you can simply push a couple buttons and the [the records are] up and running,” Fleming said. “There’s a human cost of time and effort.”
David Blumenthal, president of the Commonwealth Fund, a health research foundation, served as the Obama administration’s national coordinator for health information technology from 2009 to 2011. “I’m convinced it will reduce the rate of growth of healthcare over time,” he told reporters, but emphasized the overhaul was no quick fix. “It’s mistaken to see it as a one-year or two-year saving.”
Blumenthal said widespread improvements to patient care, and the resulting savings in cost, would take several more years to realize.
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