Hospitals Very Slow To Adopt E-Records, Study Finds

By Sacha Pfeiffer and Bob Oakes (WBUR)

http://audio.wbur.org/storage/2009/03/morningedition_0326_2.mp3

For most of us, computers are a huge part of our lives — from spread sheets to BlackBerries to Facebook. But chances are your doctor and your local hospital don't operate in the digital age as much as you do.

Massachusetts is ahead of the curve, but a new study by the Harvard School of Public Health finds that most U.S. hospitals have been extremely slow to adopt computerized medical records.

Now, the federal economic stimulus bill includes about $30 billion for digital medical records. WBUR's Bob Oakes sat down with health and science reporter Sacha Pfeiffer to talk about how the money will be spent.

BOB OAKES: Sacha, how slow are U.S. hospitals in taking up this move to electronic medical records?

SACHA PFEIFFER: Well, the researchers surveyed about 3,000 hospitals around the country to find out how many of them are using electronic records, or e-records. And they found that fewer than eight percent of all hospitals are using even a basic system.

And fewer than two percent are using a comprehensive system, meaning hospital-wide. The study also found it's mostly large urban hospitals are using them, not small ones. So President Obama wants to accelerate the adoption rate of e-records.

OAKES: I think those statistics will be surprising to many people on the other end of the radio. But explain exactly what we mean by electronic health records, e-records. For example, if my doctor has a computer database of patient information, does that qualify?

PFEIFFER: Well, at a bare minimum, it's a system that lets doctors and nurses look up medical results on a computer. It lets them take computerized notes and order tests and medications electronically. A really useful system should also be sharable among different doctors' offices, or shared by, say, you and your doctor and your pharmacist.

The idea is you get medical care that's better coordinated, doctors no longer write prescriptions in unreadable handwriting and they don't end up ordering duplicate tests. They could also avoid medication errors because the e-system would flag potential problems, like patient allergies.

OAKES: If it takes care of all those things, why are so few doctors and hospitals using them?

PFEIFFER: The main barrier seems to be cost. The average price of an e-health system for just one doctor is $40,000. And implementing one of these systems at a whole hospital can cost between $20 million and $200 million, depending on the hospital's size. Then there are also annual maintenance costs. So these things are definitely not cheap. And they're cumbersome to get going.

I asked professor Ashish Jha, who's the lead author of the new Harvard study, why he thinks many doctors are resisting the shift to electronic records.

"It's not just a matter of putting a computer in the office or on the hospital wards, " Jha said. "It really disrupts the way they work. We know from lots of evidence that it creates inefficiencies in the short run. So for three, six, 12 months, it takes longer to do the same things that doctors used to before on paper -- and that really creates a lot of resistance."

I also asked a practicing physician who uses computer records what it was like when he first made the switch. Dr. Donald Accetta is an allergist in Taunton, and he told me — he actually told me — that the transition was the worst time in his 30-year career.

"Very painful," is how Dr. Accetta  described the adjustment. "The seconds seem like hours as you're trying to figure out where to put this little piece of information or how to type it or how to fix what you just typed. So it's a difficult process."

Dr. Accetta also told me, though, that the pain was worth it because of how the system has improved his practice. "It's doable," he said. "And once you learn it, it's very easy. My medical records are, I think, a joy to read. Everyone can read them. It really made everything easy to look up and understand — track it over time. It's not perfect. But it certainly is a significant improvement from the old pen and paper charts that we used."

OAKES: So after they get through the training issues for doctors and their staffs, the systems seem to work well — at least in this doctor's experience — but what about the question of money? You said that e-systems are not cheap. Federal stimulus money will help doctors and hospitals pay for them, right?

PFEIFFER: Indirectly. The money is mainly incentive money. So, the stimulus package includes about $30 billion that will be paid out to doctors who use e-records. The payouts would come in the form of higher-than-usual reimbursements from Medicare and Medicaid. The government thinks it will eventually get back about $10 billion of that money in savings.

And, in a few years, the carrot turns to a stick. So the government plans on financial penalties for hospitals and doctors who aren't using e-records. Still, there are so many different systems out there right now that a lot of doctors and hospitals say they just aren't sure which ones to buy.

OAKES: Even if the government can get doctors and hospitals on board, what about patients who are worried about privacy issues? There are lots of concerns out there about sensitive health information falling into the wrong hands.

PFEIFFER: Right, and that's another huge issue. Anybody who's been a victim of identity theft or who's had to get a replacement credit card because of a security breach understands those risks. I mean, let's say you have an illness you don't want your employer to know about, or there's something in your medical history that you don't even want all your doctors to know about.

So, there are some privacy protection bills pending in Congress that would do things like outlaw the sale of personal health information without the patient's permission, and require audits to figure out who might have inappropriately accessed records.

OAKES: Let me come back to the money. Given that electronic health systems are still evolving, how can we be sure this sudden flood of stimulus money will be used wisely? It's not only a concern when it comes to spending on electronic medical records, it's the concern about stimulus money being used across the board.

PFEIFFER: Exactly. And there's actually a strong concern that a lot of this government money could end up being wasted because the system isn't quite ready for it yet. I asked Micky Tripathi if that's a possibility. He's CEO of the Massachusetts e-Health Collaborative, which helps doctors adopt electronic systems.

"I think that the risk is real," Tripathy said. "The risk is always real when you start having a lot of dollars flow without a clear set of goals and a clear infrastructure. And right now I would argue that we don't have either of those. So I think that there is a risk of that happening."

OAKES: So, who's going to oversee this? Who's going to oversee how the stimulus funds are spent on medical e-records?

PFEIFFER: There is a federal "health information technology czar," who happens to be local. He's Harvard Medical School professor David Blumenthal. But he was just appointed Friday and it's unclear exactly what his role in divvying up the e-records money will be.

Ashish Jha, the Harvard study's lead author, says this will be a tough process and e-records aren't a total panacea. But he does believe that we have to move forward in adopting e-records despite all the risks and challenges.

OAKES: Given that Blumenthal, though, was just appointed, this process is not going to move quickly, or is it going to move quickly?

PFEIFFER: I believe that the incentive payouts begin roughly in 2011,  and then the disincentives-- the penalties --would start about 2015. So they're on track even though they still haven't set up all the infrastructure.

OAKES: And they have time to work through it, at least another year or so.

PFEIFFER: They have a little bit of time.