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
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
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?
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
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
Results – U.S. EHR adoption
Range: Medium or
High Quality Surveys
Best Estimates:
High Quality Surveys
17% to 25%
17%
12.9% to 13%
13%
Large groups*
19% - 57%
39%
EHR: hospitals
16%† - 59%††
None
CPOE: hospitals
4% to 21%
5%
EHR: ambulatory
Solo practitioners
Cross-national comparison
Primary Care
Hospital Care
EMR
CPOE
EMR
CPOE
USA
17-18%
N/A
16%
5%
UK
>90%
>90%
8%
3%
Canada
19%
14%
<10%
25%
Australia
90%
75%
<10%
<1%
New Zealand
72%
90%
<10%
<1%
Netherlands
95%
90%
<5%
<5%
Health Information Exchange
USA
Regional Health Information Organizations
 7-10 RHIOs “functioning”
 100+ in planning stages
England
National Program for Health IT: Ambitious plan
Canada
Infoway: Imaging, labs, medications integration
Early stage: 8% to 27% complete
Australia
HealthConnect: $128M over 4 years
National backbone network
National sharing of data for imaging, prescriptions, clinical data
Still very early in deployment with some early hurdles
Slow efforts with small investments
mostly focused on broadband connection
Little data sharing occuring
New Zealand
Little activity in data exchange
Netherlands
National pilot



programs in fall, 2006
Two main features: electronic medication records
Clinical data summary
4000 Euros for GPs; 40,000 for pilot hospitals
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
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
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
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
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