The New England Journal of Medicine article, Use of Electronic Health Records in U.S. Hospitals, by Ashish Jha et al. (described here through WBUR’s excellent story on the topic), reports on results of a survey of electronic health record (EHR) adoption in all acute care hospital members of the American Hospital Association. The authors’ conclusion from analyzing the data is hardly surprising: U.S. acute care hospitals have very low levels of EHR adoption. The reasons — the expense, lack of interoperability (so that records, even if electronic, can be difficult to share), lack of technical support and know-how, unclear return on investment and sustainability, and physician resistance for these and other reasons, are hardly surprising, either.

Some of the issues that the survey does not capture, from those mentioned in the article — actual use, effectiveness, and satisfaction — to those not mentioned — nonphysician staff and patient concerns, satisfaction, and use (the latter through patient-facing web-based portals, for example) — need to be studied as well.

The lack of clarity in this area as a whole — the panel of experts undertaking the survey could not reach consensus about the definition of an EHR — is also an enormous challenge.

There are glimmers of hope, however. VA Hospitals, have had fully implemented EHR records systems “for more than a decade with dramatic associated improvements in clinical quality.” And just the fact that this survey was undertaken means that serious scientists are taking this issue seriously. After all, without a baseline, progress can’t be measured, and the good news is: we can only go up from here!
Lisa Fenichel