U.S. incentives to digitize patient records showing results, as other countries seek to benefit from health IT on care and costs.
The U.S. is not alone in striving to modernize its healthcare system, as countries rich and poor are hoping to harness technologies that could both improve care and cut costs.
But this dual challenge is particularly acute in the U.S., where healthcare spending far exceeds that of other industrialized countries but the quality of care continues to lag.
From a technology standpoint, the U.S. appears to be gaining ground, benefitting from government incentives to adopt electronic health records (EHRs). The Obama administration hopes the combination of stimulus and the reforms embodied in the Affordable Care Act will translate into better care for the buck.
“The U.S. spends 50 percent more than any other country on healthcare, and we’re not getting a huge return in terms of outcomes – if you look at how long we live, how well we do in terms of our health metrics,” said Dr. Farzad Mostashari, the country’s top health IT official. “A big part of that is going to be not just delivering care differently but paying differently for care, and engaging patients as partners in their own care.”
Mostashari told HealthBiz Decoded that a new payment system that rewards the quality – not the volume – of patient care requires a modernized health IT infrastructure.
“It’s not the IT on its own that’s going to reduce the cost of care or improve the quality of care, it’s IT as a component of new ways of delivering care with clinical leadership,” he said.
Health IT Implementation a Global Challenge
In the three years since the U.S. began its $27 billion health IT stimulus program, the percentage of physicians that reported using EHRs increased by about half – from 46 percent to 69 percent, according to a 2012 survey by the Commonwealth Fund of 10 high-income countries.
Yet while that enabled the U.S. to squeeze past France in EHR use, it remained in seventh place on the list. Perhaps more importantly, U.S. doctors were the least satisfied among those surveyed about how their health system worked, with a higher percentage of respondents saying things had gotten worse over the past three than had improved.
The report suggests that measures in the healthcare reform aimed at expanding access to healthcare and streamlining insurance practices could address such concerns, since the U.S. physicians that cited concerns about patient access or cost were the most likely to call for major changes to the system.
Countries that topped the survey in terms of EHR usage were Norway, the Netherlands and the U.K. – though fewer than half of British physicians gave their health system a passing grade.
Chris Brown, director of international business at KLAS, an Orem, Utah-based health IT market research firm, said most countries have faced some “hiccups” in transitioning to digital records. One reason is that “you have a number of vendors putting together various modules for EHR solutions,” he said.
Brown, who recently completed a study on EHR use in the U.K. and Ireland, said that while the technology is generally available in high-income countries, the success of the health IT programs depends on a number of factors – such as how the healthcare systems are funded, the resources available and buy-in from providers.
“You have innovation and really great products that come out of that, but nobody has come up with the one solution that provides every module that works seamlessly with every solution,” he said.
Despite near-universal use of EHRs in the U.K., the government’s recent program to create a single, centrally located records system is viewed by many experts as a cautionary tale. The program, which mandated which IT vendor a provider had to use, was recently scrapped in favor of a more flexible program.
After an initial period of “paralysis,” U.K. providers are showing “a lot of energy” about exploring new health IT solutions, said Brown.
Similarly, he said the U.S. is a leader in terms of “nuts and bolts” of healthcare technology and functionality. But where the system struggles is interoperability – enabling the technologies to work together – as well as impelling providers to share patient data.
Slower Progress in Developing World
Outside of the industrialized world, where the technology and the resources to acquire it are scarcer, the move toward EHRs is moving on a slower track.
Most patient data is still collected on paper, with countries in Africa and Southeast Asia reporting the lowest levels of electronic use, according to the World Health Organization’s (WHO) latest Global Observatory for eHealth survey. Fast-growing emerging economies like China and India are in the process of introducing EHRs in their systems, however.
The WHO has spearheaded efforts to support health IT in developing countries, seeing a “great potential to improve health” by enhancing access to information as well as improving the quality and reducing the cost of care. The U.N.’s public health agency found that most countries have recognized the potential of the technologies and taken steps to adopt them.
“Significantly, countries have taken the institutional steps to ensure that adoption will proceed by developing the policy, strategy, and legal foundations for solid future growth of electronic records and their electronic transmission,” the report concludes.
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