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The executive summary of the report, Health Information Technology in the United States: Where We Stand, 2008, funded by the Robert Wood Johnson Foundation and coauthored by the Institute for Health Policy at Massachusetts General Hospital and George Washington University, was released in conjunction with a study published in the June 19 online edition of the New England Journal of Medicine to raise awareness about physician adoption of electronic health records (EHR). Despite the promises it offers health care and quality improvement, a minority of US physicians have embraced EHR as a routine part of practice, according to the NEJM article. Of 2,758 physicians surveyed, only 4 percent reported a fully functional EHR system and 13 percent have a basic one. Practice size and setting are factors with a major influence on EHR adoption rates.


The survey, conducted by researchers from the Institute for Health Policy at Massachusetts General Hospital, showed that 16 percent of physicians said their practices had purchased an EHR but had not deployed it yet. Another 26 percent said their practice was planning on purchasing a digital recordkeeping system within the next 2 years. If that occurs, study authors believe it may be a tipping point resulting in significant rates of adoption.


In addition to examining at adoption rates, researchers sought to find out whether physicians find EHRs useful for practice, and the effect they have on patient care. The authors define a fully functional electronic health record as one that has a broad range of capabilities including order entry capabilities and clinical decision support. A basic EHR is one with a minimum set of functionalities such as recording laboratory data and clinical notes and electronic prescribing.


EHR use is now much more prevalent among younger physicians, primary care physicians, physicians in larger practices, hospitals and medical centers, and in the Western part of the United States. Physicians who serve a higher proportion of minority, uninsured, or Medicaid patients were equally likely to have an EHR as others.


Physicians who practiced in groups of at least 50 were three times more likely than those in very small practices (three doctors or fewer) to have a basic EHR. Nevertheless, only a minority of physicians in these larger groups (17 percent) had a fully functional EHR and 49 percent did not have an EHR at all.


Cost and complexity were found to be key barriers to adoption. Two-thirds of physicians without EHRs cited affordability as the reason they don't have an EHR. Other reasons included finding the right EHR, concern about return on investment, and that the system might become obsolete quickly.


A majority of physicians who used electronic records said they made a difference in patient care. Fully functional EHRs helped improve the quality of clinical decisions, allowed physicians to communicate more effectively with other providers, and facilitated prescription refills and avoidance of medical errors. Having a full electronic record also had positive effects on the delivery of chronic and preventive care, helped doctors avoid problematic medication interactions, and promoted more efficient ordering of critical lab tests.


One in five physicians expressed reservations about ease of use and reliability of their systems, suggesting that a significant proportion may encounter problems with their EHRs.


According to the authors, encouraging EHR adoption may require helping doctors buy an EHR either through loans, incentive programs, or directly paying them, as well as protecting them from personal liability for record tampering by external parties.


In mid-June 2008, Department of Health and Human Services Secretary Michael O. Leavitt announced that Medicare was providing $150 million to 12 cities and states to help more physicians adopt electronic health records. The five-year effort is expected to help as many as 1,200 small practices around the country switch from paper to digital recordkeeping.


Health Information Technology in the United States: Where We Stand, 2008, was published in full in early July 2008 by the Robert Wood Johnson Foundation. For copies of the survey, "Electronic Health Record Adoption in the Ambulatory Setting: Findings from a National Survey of Physicians," contact Isha Mehmood at Burness Communications, mailto:[email protected]



The University of Texas at San Antonio's (UTSA) Institute for Cyber Security (ICS) has been selected to participate in a 5-year, $7.5 million Department of Defense Multi University Research Initiative (MURI) grant.


In partnership with The University of Maryland at Baltimore County, Purdue University, University of Illinois at Urbana-Champaign, University of Michigan, and The University of Texas at Dallas, UTSA's Institute for Cyber Security Research role will be to develop and test security models to safeguard the transfer of data among government agencies.


One of the UTSA principal investigators, Ravi Sandhu, who holds multiple positions as executive director of ICS, Lutcher Brown Endowed Chair in Cyber Security and as a professor in the UTSA Department of Computer Science, said, "In this post 9/11 era, we need to move from the doctrine of a 'need to know' policy of information gathering to a more proactive one of 'need to share', where people are readily seeking and receiving information."


The UTSA Institute for Cyber Security was created in June 2007 with a $3.5 million grant from the Texas Emerging Technology Fund. This award was the first proposal submitted by the ICS and will bring $1 million directly to UTSA. The ICS mission is to produce world-class cybersecurity research and to catalyze the commercialization of leading edge security and privacy innovations.


MURI grants support multidisciplinary basic research in areas of DoD relevance. Areas of research in which more than one traditional science and engineering discipline intersect benefit from multidisciplinary approaches, which can accelerate both basic research progress and transition of research results to application.


The University of Texas at San Antonio, founded in 1969, is the second largest of nine academic universities and six health institutions in the UT System. UTSA serves more than 28,500 students in 64 bachelor's, 44 master's and 20 doctoral degree programs in the colleges of Architecture, Business, Education and Human Development, Engineering, Honors, Liberal and Fine Arts, Public Policy, Sciences and Graduate School.