Health IT Adoption: A cross-national comparison

1. Health IT Adoption: A cross-national comparison Ashish K. Jha, MD, MPH Harvard School of Public Health Brigham and Women’s Hospital VA Boston Healthcare System June 26, 2006 Funded by: The Commonwealth Fund, New York, NY

2. Background • Healthcare costs rising in many nations • Quality of care variable, often inadequate • The promise of health information technology • Will increase quality • Will improve efficiency • Will improve coordination of healthcare • Despite major policy focus • Level of HIT adoption in the U.S. unknown • How U.S. compares to other nations also unknown

3. Research Questions • What is the level of HIT adoption in the U.S.? • How does it compare to other nations? • What are the major programs currently in HIE?

4. Methods • A comprehensive review of U.S. surveys • Rating of surveys based on methodology, content • Ratings criteria developed by group of experts: • Sampling technique, response rate • EHR content • Reviews of surveys from other nations • Interviews from experts

5. Results • Health IT in the U.S. • 35 surveys of physicians and other providers • 21 surveys available for rating • 16 surveys of EHR adoption in ambulatory care • 5 surveys of EHR adoption in inpatient care • Few surveys of high quality • Nine high quality in methodology • Eight high quality in EHR content • Four surveys high quality in both areas

6. Results – U.S. EHR adoption

7. Cross-national comparison

8. Health Information Exchange

9. Discussion • U.S. adoption rates of EHR low • Lack of good estimates • Less than 1 in 5 ambulatory physicians using EHR • Approximately 1 in 20 hospitals using CPOE • Other nations ahead on ambulatory EHR • U.S. has lowest rate of EHR use in ambulatory care • Substantially behind Australia, UK, NZ and Netherlands • Lack of high quality data make other assessments difficult

10. Discussion • Poor adoption rates in hospitals • No nation has moved substantially in this area • Different levels of activity on data exchange • Major efforts in UK, Canada, and Netherlands • Slower efforts in US, Australia, and NZ • Even well touted programs running into obstacles

11. Limitations • Important caveats to adoption data • U.S. estimates based on few high quality surveys • Large confidence intervals when other surveys included • Data from other nations not rigorously evaluated • Most surveys don’t distinguish “have” from “use” • Field rapidly changing

12. Implications • Health IT adoption varies across nations • U.S. behind in ambulatory EHR use • Likely will need greater access to capital to improve • IT in hospitals widely neglected • Best evidence for improving care • New efforts to focus on hospital IT • HIE very early in deployment • No single approach will work for all nations • Adequate funding just part of the challenge

13. Acknowledgement • HIT Adoption Initiative – funded by ONC • Tim Ferris • Karen Donelan • Alex Shields • Cait DerRoches • Sara Rosenbaum • David Blumenthal • Cross-country Initiative – funded by CMWF • Doreen Neville • Tim Clark • David Doolan • David Bates