U.S. leads many nations in health IT

When it comes to health information technology adoption and use, the United States is among the worldwide leaders, according to research by Accenture.

About half of all specialists and primary care doctors are using the technology, the organization said.

The management and technology research and consulting group interviewed physicians and health IT leaders from eight countries, including the United States, to determine how mature use is among health care organizations in each nation.

"This research basically says that if you think about maturity as the intersection between adoption and exchange of information, the United States is actually pretty consistently more in the advanced group than has been previously recognized," said Kaveh Safavi, MD, managing director of Accenture's North American health practice.

Dr. Safavi said the United States' success has to do with a combination of top-down (government mandates, for example) and bottom-up (physician choice) approaches to health IT adoption. He said one thing that was made apparent in the research was that countries that approached health IT adoption either from an all top-down approach -- or all bottom-up approach -- were unsuccessful.

Meaningful use seen as key

In the United States, for example, 20 years of private-sector initiatives around the adoption of health IT combined with the past few years of public initiatives, such as meaningful use incentives that drove the concept of health information exchange, led to the U.S. surpassing other countries, Dr. Safavi said.

"One could speculate that had we not had the benefit of four years of ... various incentives, we might not have been in the same place, because [private initiatives alone] would not have driven exchange. Meaningful use drove exchange," he said. Meaningful use came out of the Health Information Technology for Economic and Clinical Health Act, which was part of the 2009 economic stimulus package.

"In order to get exchange, you do have to have some level of consistency and some level of purpose that creates a relationship between all the various participants," Dr. Safavi said.

For the study, researchers interviewed more than 160 government officials, health care leaders and analysts in the U.S., Australia, Canada, England, France, Germany, Singapore and Spain, and surveyed 3,700 physicians across all eight countries.

The nations were not ranked by number, but the data were mapped out on Accenture's Connected Health Maturity Index, which compares each country's adoption of health IT and health information exchange between clinicians and organizations. Where primary care physicians and specialists landed on the index chart showed how each country compared with the others.

The group found that the United States performed above several other countries in use of health IT and was a leader in many health information exchange capabilities such as e-prescribing, computerized physicians order entry and e-referrals, with 62% of specialists using those tools compared with the global average of 49%.

When it came to data sharing, the report showed that 44% of specialists and 39% of primary care doctors in the U.S. share patient data outside their organizations to improve disease management.

Primary-specialty balance

Helping the U.S. was the fact that it has near-equal rates of adoption and use of health IT among specialists and primary care physicians (at about 45%), which means better integration of care delivery. Spain, for example, had higher use of health IT in primary care, with 58% routinely using health IT and 52% regularly participating in health information exchange. But adoption and use among specialists in Spain was less than 45%.

Jerold Howell, principal with KPMG Healthcare IT Advisory practice, agrees that the U.S. needed a bottom-up approach as far as allowing each organization to choose which system is best for itself, as opposed to pushing the same solution out to everyone. But the government regulations were necessary to make data exchange possible.

"I know from my experience here in the U.S. how hard it is to even do one single implementation across a single health system that has multiple hospitals," he said.

The stimulus package does not tell hospitals how to practice medicine, Howell said, but it has set standards that must be met. "And I have not heard any griping from any of our clients that the standards are wrong. They may not like the fact that they have to strive to achieve them, but I have not heard anyone who has said the standards are wrong or shouldn't be there."

Harry Greenspun, MD, senior adviser of health care transformation and technology for the Deloitte Center for Health Solutions, said meaningful use did two things to spur adoption. First, it clarified what it means to use an EMR. Second, it helped simplify the process for practices looking to buy an EMR by telling them what they would need to qualify for meaningful use.

Dr. Greenspun agreed that government standards will enable health information exchange, which will lead to improved quality and safety and lower costs.

He said it's no different from the automobile industry. "There's tremendous variety in cars and in transportation, despite the fact that underneath it, they all have to have safety systems that meet certain things or emissions that meet a certain standard. There's still plenty of room for innovation, but at the same time ... when I put my kids in the car, I know it meets a particular standard that is important to me."