Diagnostics & Imaging Week Washington Editor

A recent study shows that less than a third of the nation's hospital emergency and outpatient departments use electronic medical records, and even fewer doctors' offices do.

According to a report released last week by the Centers for Disease Control and Prevention's (CDC; Atlanta) National Center for Health Statistics (NCHS; Hyattsville, Maryland), about 31% of hospital emergency departments, 29% of outpatient departments, and 17% of doctors' offices have electronic medical records to support patient care.

The report was compiled from annual ambulatory medical care surveys conducted by NCHS from 2001 to 2003. But Catharine Burt, lead author of the study, said the results "weren't getting much attention," so the agency decided to package them together to track trends in the adoption of electronic medical records (EMRs), also known as electronic health records, or EHRs.

"The purpose of this particular article was to draw attention to this, and put all out information in one place," Burt told Diagnostics & Imaging Week.

The use of electronic records in healthcare lags far behind the computerization of information in other sectors of the economy, which is not much of a surprise to healthcare professionals.

It also has been the subject of much recent media and political attention. Last year, President George Bush called for the majority of Americans to have electronic health records within 10 years and appointed David Brailer, MD, as the national coordinator for health information technology.

In healthcare, billing applications were the first to be computerized. Electronic billing systems are used in three-quarters of physician office practices, but computerization of clinical records has been much slower.

"I would have thought that more than 30% of emergency departments would have electronic medical records," Burt explained when asked what surprised her most about the report's findings. "I think the virtues of EMRs have been touted for quite a while, and to find out that only a third of hospitals are using them is kind of amazing."

She said that the cost of the systems undoubtedly has been a barrier to their adoption, especially by smaller physician practices.

"Electronic medical records and computerized systems offer opportunities to improve the quality of medical care in all settings as health care providers learn the potential of these systems and how to use them," Burt said.

The survey measured the use of systems to improve the accuracy and safety of prescription drug use. About 8% of physicians use a computerized physician order entry system, in which orders for drugs and diagnostic tests are entered electronically rather than on paper prescription pads. In these electronic systems, the computer compares the order against standards for dosing, checks for allergies or drug interactions, and warns of potential patient problems.

The study found younger physicians, those younger than 50, were twice as likely as physicians older than 50 to use this computerized system for ordering prescriptions.

About 40% of hospital emergency departments use automated drug-dispensing systems, compared to about 18% of outpatient departments.

Many other studies have shown that automated drug-dispensing systems which operate like vending machines where the order is written and the machine dispenses the correct drug and dosage for patients are able to reduce medical errors.

According to the study, those kinds of automated systems were more likely to be in use in emergency departments located in metropolitan areas and those with the highest volume of patients. For outpatient departments, medical school affiliation also was associated with use of automated drug systems.

Burt said the results contained in this report provide a good baseline for what the actual current state of EMR usage is in the U.S.

"When Dr. Brailer's report came out this summer after a big push by the Department of Health and Human Services, nowhere in it did they mention our statistics," Burt said. "They mentioned a lot of statistics from web-based surveys, but those aren't necessarily nationally representative."

She said web-based surveys are inherently biased toward respondents who already are comfortable with technology and automation.

"Also, a lot of the surveys only go to large practices and don't sample individual solo parishioners or group practitioners," Burt added.

Burt said the results of the 2004 survey are currently being compiled and reported later in the year. She said the new numbers undoubtedly would reflect a growth in usage.

"Certainly since last summer there has been a push," she said. "Medical associations are encouraging doctors to use them, and the cost is coming down some from $20,000 [per system] to about $10,000."

Brailer has said that the government must create incentives for healthcare providers to adopt electronic medical records in addition to enacting compatibility standards

"While national adoption rates for health information technology are slowly climbing, we are seeing a widening gap between larger hospitals and physician groups and their smaller counterparts," Brailer said recently. "Physicians and providers face many barriers to adopting health information tools."