LOS ANGELES — U.S. hospitals have a long way to go to join the digital age. Fewer than 2 percent have abandoned paper medical charts and completely switched to electronic health records, a new national survey found.
Another 8 to 11 percent of hospitals have basic electronic systems in place where at least one department has converted to digital.
The sobering findings come as the Obama administration plans to spend $19 billion to help modernize medical-record keeping systems.
“We are at a very early stage in adoption, a very low stage compared to other countries,” said Dr. David Blumenthal, head of the Institute for Health Policy at Massachusetts General Hospital.
Blumenthal, who was named the nation’s new point man for health information technology last week, was among the authors of the new survey published in Thursday’s New England Journal of Medicine. The group previously found only 17 percent of American doctors have traded their paper patient charts for digital ones.
The new numbers come as no surprise. Hospitals and doctors have been slow to make the leap to paperless despite evidence suggesting electronic health records can improve efficiency and help reduce deaths and injuries caused by medical errors.
The Bush administration had set a goal of 2014 for converting medical records to digital. The push got a boost earlier this year when Obama signed an economic stimulus bill that contained $19 billion for computerized medical records, including $17 billion for incentives and penalties to encourage doctors and hospitals to switch out their 19th century filing systems.
The most common obstacle to conversion cited by the surveyed hospitals was cost – $20 million for small hospitals to $200 million for large academic centers. About three-quarters of hospitals without a computerized system said lack of capital was a barrier, 44 percent cited maintenance costs and 36 percent cited doctor resistance, according to the survey of 2,952 mostly small and medium U.S. hospitals conducted last year.
The research was funded by the Department of Health and Human Services and the Robert Wood Johnson Foundation. It is considered the most comprehensive look to date at the use of digital health records in hospitals. It did not include Veterans Affairs facilities, which have been using computerized medical records for a decade.
Researchers divided hospitals into two camps: Hospitals where all departments can view lab results, jot down notes, prescribe medicine and perform other chores electronically were credited with having a comprehensive system. Those with at least one department going digital were considered to have a basic system.
The survey found only 1.5 percent of hospitals had comprehensive systems and another 8 to 11 percent had basic systems. There was no difference in adoption rates between private and public hospitals.
Whether electronic health records will lead to dramatic cuts in health care spending is debatable. The Institute of Medicine has said a serious drug error can add more than $8,750 to the hospital bill of a single patient.
But a third of hospitals surveyed said they were unsure whether they would recoup their investment. And the Congressional Budget Office last year said the adoption of more health technology alone is “generally not sufficient to produce significant cost savings.”
Lead author Dr. Ashish Jha of the Harvard School of Public Health said the survey underscores the difficulties the Obama administration faces as it tries to bring hospitals into the digital age.
“He has an enormously difficult challenge,” Jha said of Blumenthal’s new role as health technology coordinator. “It is not going to be one of the easier things he takes on in his career.”
Jha, an internal medicine doctor at the VA hospital in Boston, is among the early champions of electronic health records. Every morning, he logs onto his computer at home to see how his patients fared the night before. By the time he reports to duty, Jha said he has more time to spend with patients and often uses the computer to let patients see what he’s looking at.
“I can spend a lot more time focusing on my patients because I’m not running around looking for their charts,” he said.
For digital health records to become more widespread, advocates have noted that different computer systems must be able to talk with one another. Currently, many hospitals that have gone electronic have systems that cannot share information with another hospital or doctor.
Don May, vice president for policy at the American Hospital Association, said its members have been pushing to get various digital record-keeping systems to work together. May compared the electronic health records dilemma to the recent battle in the entertainment world to become the standard format for high-definition movie discs.
“Do you buy Blu-ray or HD DVD? Which one is going to win out? These are tough decisions,” May said.