BOSTON – U.S. hospitals have a lot of work to do to transform the current paper-based healthcare system to an electronic one, say the authors of a new Harvard study.

The study, which was conducted by researchers from the Harvard School of Public Health (HSPH), found adoption of basic or comprehensive EHRs by U.S. hospitals increased modestly from 8.7 percent in 2008 to 11.9 percent in 2009.

"Getting hospitals to start using EHRs is critical," said lead author Ashish Jha, associate professor of Health Policy and Management. "Paper-based medical records lead to hundreds of thousands of errors each year in American hospitals and probably contribute to the deaths of tens of thousands of Americans. This is not acceptable. There is overwhelming evidence that EHRs can help, yet the expense and the disruption that implementing these systems can cause has forced many hospitals to move slowly."

The researchers drew from a survey by the American Hospital Association, which asked 4,493 acute-care non-federal hospitals about their health information technology efforts as of March 1, 2009; 3,101 (69 percent) responded. A representative from each hospital reported on the presence or absence of 32 clinical functions of an EHR and how widely they had been implemented throughout the hospital. Responses were statistically adjusted to balance for hospitals that did not respond.

Hospital responses showed that their adoption of basic or comprehensive EHR systems increased by 3.2 percent between 2008 and 2009. Based on the measures examined by the authors, only approximately 2 percent of U.S. hospitals described EHRs that meet meaningful use guidelines including 14 core functions, such as prescribing electronically and keeping an active medication list for patients, that would allow the hospitals to qualify for incentives in 2012.

Researchers also found that smaller, rural, and public hospitals fell further behind their larger, private, and urban counterparts in adopting EHRs.

The government's financial incentives may go primarily to larger, academic hospitals, further widening an already large digital divide, says Jha. Given the state of the economy at the time the survey was conducted, he says he is not surprised that adoption rates for EHR systems, which can cost tens of millions of dollars to purchase and implement, remain low.

"The problem is that the bonuses that hospitals get for meeting meaningful use are front-loaded, meaning hospitals have to implement and use EHRs by 2012 in order to get the bulk of the incentives," Jha said. "This is an aggressive timeline, and many hospitals may not make it. If they miss out, it may be years before many of these hospitals will be able to afford to purchase and install their own EHR systems."

"A Progress Report on Electronic Health Records in U.S. Hospitals," appears in Health Affairs.