eWeek Survey: Few Doctors Use Electronic Records, Fewer Use Adequate Systems

eWeek ran an article about a "survey of surveys" of EHR usage in the US recently conducted by the Institute of Medicine: Survey: Few Doctors Use Electronic Records, Fewer Use Adequate Systems.  It was also mentioned in Government Health IT in an article titled Doctors' use of EHRs may have been overestimated, study finds.

From the eWeek article:

...the study singled out one particular survey, the National Ambulatory Medical Care Survey, as particularly reliable. This is an annual, government-funded, nationally representative survey of all ambulatory visits to physicians whose practices are not hospital-based. It puts EHR use at 23.9 percent, but said only 9 percent of EHRs incorporated at least four of the functions recognized as key.

This helps to explain the low quality and high cost of US healthcare. Is there a solution?

Another fact that should be considered particularly frightening:

Only about one in 20 hospitals use computerized [prescription] order entry systems. [aka CPOE]

Given that prescribing errors are a major reason for initiating malpractice suits against hospitals, it would seem there is adequate incentive to make CPOE systems universal.

"Despite the potential importance of EHRs, there is a surprising lack of consensus about just how prevalent—or, more accurately, just how rare—they are in the current health care system," said Ashish Jha, assistant professor of the Harvard School of Public Health and lead author on the study. Other researchers were from the Institute of Health Policy, Harvard and George Washington University.

US healthcare policymakers need to look at the incentives in the system and why they are not working. Legal liability is a poor disincentive to murder, and malpractice liability is an equally bad way to motivate practitioners and administrators to adopt EHR.

If anything can motivate EHR adoption, it will be pay-for-performance. P4P requires accurate record-keeping, which in practice translates to a workable EHR. P4P will be best achieved through a combination of EHR and prompt and reminder systems like Cielo Clinic. 

Integrated EHR and P&R systems not only keep the clinicians focused on best-practices treatment and prevention protocols, they can also improve profitability by ensuring that all billable procedures are performed when warranted. In turn, the EHR captures the billable event, ensuring payment will be requested. Liability reduction becomes a side effect of near term improvements in profitability and quality of care.