Most hospitals still use paper records, and why money alone won’t solve the electronic medical record problem

New numbers have recently come out, highlighting how low the adoption rate is for electronic medical records in hospitals.

As reported by MedPage Today, the study from the NEJM found that only 1.5 percent of hospitals surveyed had comprehensive electronic medical record systems. That’s a piss-poor adoption rate, and far lower than the dismal numbers in small office practices.

The reasons cited are no surprise to regular readers of the blog, and according to the survey, “some 30% said the return on investment was unclear, 45% pointed to maintenance costs, about 30% did not have adequate information-technology staff, and about 35% worried about physician resistance.”

To the government’s credit, they are allocating some $19 billion to the problem. But, despite cost being a primary factor of digital adoption reluctance, I don’t think that money alone will solve the problem.

The larger issue is that the current generation of digital record systems, to put it bluntly, suck.

The accompanying perspective piece sums this fact up nicely, writing, “the current health record suppliers [are] offering pre-Internet era software “” costly and wedded to proprietary technology standards that make it difficult for customers to switch vendors and for outside programmers to make upgrades and improvements.”

I completely agree with the proposed solution to the problem, by “[encouraging] the development of an open software platform on which innovators could write electronic health record applications.”

For instance, imagine an open-source system that allows seamless installation of applets, such as those found in the iPhone or Facebook.

We’re so far away from that kind of technology, that simply pouring money into the what we currently have may actually impede the innovation needed to make digital medical records more usable.

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  • Leonard Kish


    I think you’re right. An open, web-based system that allows doctors to get their jobs done better at low cost will be what finally tips the scales towards the use of electronic records. That would solve all of the concerns at virtually no cost to the hospitals. Just need to get over connectivity and privacy hurdles, but it will happen. I’m not sure we’re as far away as you think, but you may be right that throwing money at the old way of doing things will get in the way.

  • Reality Rounds

    Most hospitals continue to use paper records because you are right, the current EMR systems used today SUX. It is extremely difficult to retrofit these old systems to current technology. The current systems used today are cumbersome and confusing. It takes twice as long for an MD to put an order in, and it takes twice as long for the RN to find that order. I agree money alone will not solve this problem. Although, maybe with the hint of money, some innovative ideas regarding EMR will emerge. We need to start from scratch. I have heard some systems used in VA hospitals are pretty good (?).

  • Anonymous

    i have seen the va system it is not that good, and is very difficult to figure out, I tried as an intern to figure it out and couldn’t do it.

    what about those of us who go to 3 or 4 hospitals do we have to learn 4 systems and I have my own emr, so i have to learn that one as well, at least with paper you can just walk in and do the work.

    also what about traveler nurses you won’t be able to hire travelers because it will take weeks of training to get them working.

  • Anonymous

    The role of the government in the evolution of EMR should be to enable rather than obstruct but not to dictate, standardize, or subsidize. With that policy, over time a few functional efficient systems will emerge can talk to each other and will, by necessity, be those that enhance the clinical and business operations of providers. Mandates and subsidies will keep inefficiencies longer–perhaps even make them permanent parts of the structure.

    Like with Mac and PC, the surviving platforms will eventually be able to readily exchange information because the customer will demand it.

  • Stephen Holland

    Great post. Right to the point. I despaired when I heard that EMR software was getting supported by the government. A 3% Medicare reward will not compensate for the productivity loss we will see.

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