About one in four doctors use some form of electronic health records, suggesting that a technology frequently billed as a way to improve the quality and efficiency of care has yet to win widespread acceptance, according to a study released yesterday.
Fewer than 1 in 10 use such records in the most effective way -- as part of a system that collects patient information, displays test results, helps doctors make treatment decisions and allows health-care providers to document prescriptions and medical orders electronically, the study found.
There are indications, though, that an increasing number of doctors are adopting electronic record systems every year, said David Blumenthal, an author of the study and the director of the Institute for Health Policy at Massachusetts General Hospital in Boston. The research was funded by the Robert Wood Johnson Foundation.
"This is a kind of tipping-point phenomenon, where if you get to a certain point, it might really take off," Blumenthal said. "We just don't know where we are with respect to that potential tipping point."
President Bush has set a goal for most Americans to be covered by electronic health records by 2014.
Advocates, including the pharmaceutical and technology industries, argue that standardized electronic records that can be shared among care providers would improve patient care, reduce errors, curb unnecessary tests and cut paperwork. They also would ensure that patients who see different specialists, switch doctors or move frequently would not have to repeatedly recite their medical history.
But the concept is controversial among many privacy advocates, who fear that sensitive personal information could be accidentally compromised or exploited by hackers, companies or the government.
"The big problem is that the vast majority of electronic medical-record systems do not give patients the right to decide who has access to the records," said Deborah C. Peel, a psychiatrist and founder of Patient Privacy Rights, an Austin-based nonprofit that wants greater safeguards. "They do not give patients the right to segment sensitive portions. . . . The electronic medical records in use now have been designed primarily for the convenience of physicians."
To date, there has been little hard data on electronic-record use and why and where the technology has been slow to catch on.
Karen M. Bell, director of the Office of Health IT Adoption in the Department of Health and Human Services, called the new study a "seminal report" that could serve as an important annual benchmark.
That relatively few doctors use the technology "doesn't surprise us," she said. "We know that there has been an issue with the adoption of electronic health records for some time."
In conducting the study, researchers from Massachusetts General and George Washington University combed through dozens of surveys done since 1995 and tried to piece together reliable estimates on the use of electronic health records.
They found that doctors practicing alone or with one other doctor were much less likely to use the records. That is significant because half of all doctors in the United States practice in such settings, said Ashish Jha, an assistant professor at the Harvard School of Public Health, who helped lead the study. Estimates of electronic record use in hospitals were not possible, Jha said, but about 5 to 10 percent of hospitals use computerized entry of prescription orders.
Blumenthal said evidence suggests that doctors in metropolitan areas are adopting the technology more quickly than those in rural communities, and that physicians in the West are more likely to embrace it than those in the South, Midwest and Northeast.
Researchers attributed the slow adoption rates to the expense of the systems and the disruption they cause initially, forcing doctors to change the way they work.
"There is very compelling evidence that at the end of the day, once you have good implementation and you're done, your systems work better," Jha said. "But getting there is not easy, and both the financial and disruptive elements have held a lot of doctors and hospitals back from taking this on."
