Implementation of electronic medical records by U.S. hospitals and doctors’ offices could save from $80 billion to $100 billion per year in healthcare costs, but if it is not done properly, it might not improve the quality of care being delivered, according to Ashish Jha, associate professor of health policy and management at HSPH.

“Just implementing a system itself is not going to have a big impact on the quality of care,” Jha said during an HSPH Community Forum on health information technology Sept. 17 in Kresge. “The systems have to be designed smartly and used effectively in order to impact quality."

The forum was entitled "Health Information Technology: Adoption, Use and Potential Impacts on the U.S. Health Care System."

A study authored by Jha, published in the New England Journal of Medicine this year, showed that less than 10 percent of U.S. hospitals have adopted electronic medical records even in the most basic way.

Only 1.5 percent have adopted a comprehensive system of electronic records, including physicians’ notes and orders and decision support systems that alert doctors of potential drug interactions or other problems that might result from their intended orders.

Large hospitals, including teaching hospitals, were the most likely to have implemented electronic medical record systems, he said. Still, only 20 percent of these have done so. There is also evidence that hospitals that cater to the poor are slightly less likely to have implemented such systems compared to hospitals in general, he said.

Jha was also lead author of a recent study in Health Affairs that suggests that hospitals serving a disproportionately large share of poor patients are lagging behind other hospitals in adopting electronic health records (EHR).

While the barriers to implementation include such things as physician resistance to change, the overriding issue is financial, he said. “The biggest issue is money, money, money,” he said.

Costs include not just startup, but also IT backup and training of doctors and nurses to use the systems. Jha said it can cost hospitals from $20 million to $200 million to implement an electronic record system over several years, depending on the size of the hospital. It is estimated to cost about $50,000 to outfit a doctor’s office, he said.

The good news is that President Obama’s stimulus package includes $30 billion to implement such systems nationwide, although the law requires hospitals and doctors to pay the costs up front and then be reimbursed if they meet certain measures, including showing that their systems are improving quality of care, he said. Measures would include lower mortality or infection rates, for example.

But Jha warned that simply adopting electronic record systems — hospitals can use their own homegrown systems or buy standardized systems — does not mean better care.

Another study he has done, which has yet to be published, shows that hospitals that have implemented electronic record systems have fared no better on quality measures.

“The money in the stimulus bill is going to help a lot in terms of getting systems adopted,” Jha said. “You’re going to see this entire field change dramatically in the next several years. You’re going to see new vendors getting into this field who haven’t been there before. I’m hopeful this will mean better products that will require less training. There’s no doubt in my mind that five years from now, we are going to have far more widespread use of electronic health records.”

He added: “Whether we are going to get to 90 percent as President Obama has said he wants, I’m not sure. But the bottom line is that this train has left the station. We’re moving towards electronic records. The only question is whether we can do it well. The big challenge for us is to make sure we adopt these systems effectively, that we remember the prize is not electronic records; the prize is higher quality at lower cost. And that’s only going to happen if we really think through how to adopt these systems in a more organized and effective way.”

— Michael Lasalandra. Photo (c) iStockphoto.com/VisualField