President Obama is counting on electronic health records to help modernize the nation’s dysfunctional health care system, improve the quality of care and reduce its cost. His stimulus package will provide $19 billion over the next two years to promote the adoption and use of health information technology, and he has pledged to spend some $50 billion in all over five years.

There is a long way to go. A new study reveals that American hospitals have been appallingly slow to adopt electronic records, just as previous studies have shown that American physicians have been very slow to computerize their operations. By contrast, a vast majority of doctors in four other industrialized nations have adopted electronic records, although hospitals are thought to be lagging.

The study was published in The New England Journal of Medicine and led by Harvard researchers, including Dr. David Blumenthal, who has been chosen by Mr. Obama to be national coordinator of health information technology.

The researchers surveyed some 3,000 acute-care hospitals last year. Only 1.5 percent had a comprehensive electronic-records system in all major clinical units that performed all 24 functions deemed important by a panel of experts. Such systems incorporated physicians’ and nurses’ notes, the ability to order laboratory and radiological tests, clinical guidelines on how to treat various conditions and alerts to avoid dangerous drug interactions, among other capabilities. Only 11 percent of the hospitals had even a basic system in at least one major clinical unit that performed eight functions.

The main impediment is money. Many hospitals simply do not have the capital to buy systems that can cost $20 million to $200 million, especially when so many are struggling to remain solvent. Hospitals also worry about high maintenance costs, an uncertain payoff on their investment, a lack of staff with adequate technical expertise and resistance from doctors.

The president’s stimulus plan should help ease the financial obstacles. It will provide $17 billion in financial incentives (higher payments through Medicare or Medicaid) to get hospitals and doctors to adopt electronic health records and will impose financial penalties on those that do not. Another $2 billion will help hospitals and doctors keep their systems working and up-to-date.

The ultimate goal is an “interoperable” system that would allow easy exchange of clinical data between hospitals and doctors. The modernization effort will have limited value if a mélange of different computer systems can’t talk to one another.

Above article published on www.nytimes.com