While the share of U.S. hospitals that had adopted either basic or comprehensive electronic health records rose modestly between 2008 and 2009, from 8.7 percent to 11.9 percent, only 2 percent of this country’s hospitals reported having records that would meet the federal government’s “meaningful use” criteria.

These findings are reported today in a Health Affairs Web First article by Harvard’s Ashish Jha, who is serving as a senior adviser to the under secretary for health of the Veterans Health Administration and coauthors. Even with the passage of the American Recovery and Reinvestment Act and with the new financial incentives soon to be offered by the federal government to Medicare and Medicaid providers who can demonstrate that they meet the criteria, the findings in this study—which was completed after the passage of the stimulus legislation—make it clear that the transition to a digital health care system will be a long one.

To compile their data, Jha and coauthors used responses to a 2009 survey by the American Hospital Association of all acute care, nonfederal hospitals about their health information technology (IT) activities as of March 1, 2009. Of the 4,493 hospitals surveyed, 3,101 provided information.

The authors found that there was wide variation in the rate of adoption of individual health IT functions. For example, 85 percent of the responding hospitals had fully implemented electronic radiology reports in at least one hospital unit, compared to 66 percent of respondents that had fully implemented medication lists, and 33 percent that had fully implemented physician notes.  Public and rural hospitals had 40 percent lower odds of having adopted basic electronic records in the year before the survey, compared to private nonprofit and urban hospitals. 

While the authors reported some progress, their findings suggest areas for concern, with less than 2 percent of hospitals able to achieve meaningful use using the measures examined by the authors. “It is unclear whether the implementation of the Medicare and Medicaid meaningful-use incentive payments will help close these gaps or further widen them,” say Jha and coauthors Catherine DesRoches of Partners Healthcare in Boston, Peter Kralovec of the Health Forum, and Maulik Joshi of the Health Research and Educational Trust and the American Hospital Association. They conclude:

A growing gap in the adoption of electronic health records has potentially important consequences for the health of Americans and the quality of hospital care they receive.… Policy makers need to consider ways to make it easier for hospitals to adopt electronic health records and meet the criteria for their meaningful use—especially in the case of smaller, rural, and public hospitals … to ensure that all Americans, regardless of where they receive care, derive the benefits that health IT has to offer.

Support for the survey was provided by the Office of the National Coordinator for Health Information Technology, in the U.S. Department of Health and Human Services.