Hospitals are laying the groundwork for EMRs

Hospitals nationwide are increasingly focusing on implementing full-blown electronic medical records systems, according to a survey released by an American Hospital Assn. publication.

The survey identifies the "most-wired" and "least-wired" hospitals in the nation.

In 2004, 64% of hospitals had a patient's current medical record (observations, orders and progress notes) -- one of the four core components of an EMR, says Hospitals & Health Networks -- compared with 24% in 2000.

But while the survey by the monthly AHA journal indicates that hospitals have steadily moved toward assembling an EMR since 2000, overall only 13% have an EMR, according to the U.S. Dept. of Health and Human Services.

H&HN does not specifically ask whether hospitals have an EMR because the system combines multiple tasks and functions, said Alden Solovy, the journal's executive editor.

"But what we did see this year ... is this relative steady progression over the years in hospitals investing in those types of functions that are at the core of an EMR," he said.

"What that doesn't say is [if] these things have yet been linked into an integrated [electronic] record. We're seeing essentially the groundwork being built [for that]," Solovy said.

The current medical record is one of four core components of the EMR, he said. Medical history, patient demographics and nurses' notes are the others, he said.

In 2004, 90% of the most-wired had current medical records; 87%, medical history; 88%, patient demographics; and 69%, nurse's notes online.

In comparison, 16% of the least-wired hospitals had current medical records; 21% had medical history, 25% had patient demographics and 7% had nurses' notes.

Those results are based on responses from 482 health systems representing 1,298 hospitals, or about 20% of the country's 6,000 hospitals. Of those, 101 health systems made the "most-wired" list. The remainder were classified as least-wired.

The list of the most-wired hospitals has a 20% to 30% annual turnover. Hospitals fall out of the list because they either fail to participate in the survey or are muscled out by new participants.

The survey, which had 404 respondents in 2003, examines how health systems use technology to solve problems in five areas: safety and quality, business processes, work force, public health and safety, and customer service.

CPOE findings

The survey also found that hospitals are beginning to adopt patient safety technologies, including computerized physician order entry systems. For example, about 27% of all medication orders on average are electronically entered by physicians at the most-wired hospitals compared to 12% for all respondents and about 3% for the least-wired.

The survey's findings suggest that more physicians will be entering orders electronically in coming years, said Mark Wheeler, MD, chief technical architect at IDX Systems Corp., a Burlington, Vt., health care software company that co-sponsored the AHA survey.

"What physicians will find is that they will actually have to spend a little bit more time putting in orders [electronically] on behalf of patients and interacting with the computers to enter other things like progress notes and so on," he said.

Although many doctors resist using electronic prescribing technology because it's more time-consuming than writing orders on a piece of paper, Dr. Wheeler said he's starting to see a shift in their attitude toward technology.

That's because physicians are starting to realize that electronic order entry ultimately saves them time and hassles, said Dr. Wheeler, a former pediatrician.

As hospitals begin to go live with systems that they bought two years ago or aggressively expand the functionality of existing systems, "we're going to see a much more rapid penetration of physician use of technology than we have in the past," Dr. Wheeler said.