Health information exchange—a process that aims to simplify and improve patient care by connecting doctors and hospitals—hasn't been catching on as fast as policymakers hoped, a new survey finds.

The results also show that organizations responsible for coordinating the digital exchange of patient records are rarely financially viable, and only a few support the type of information exchange that the government deems necessary.

"Part of meaningfully using electronic health records is the ability to send and receive data between systems," Julia Adler-Milstein, one of the study's authors from Harvard Business School, told Reuters Health. "A lot of the value comes from having complete patient information at the point of care, and not all patients see the same doctor for their whole lives."

One way to address that, she said, has been through government-funded regional health information organizations, or RHIOs, which sign up doctors and hospitals in a specific area and coordinate the transfer of electronic patient information between providers.

For their new report, Adler-Milstein and her colleagues surveyed every RHIO in the United States in late 2009 and early 2010.

Out of 197 RHIOs the researchers identified, 165 returned their surveys, and 75 of those were currently operational. Those organizations covered a total of 14 percent of hospitals in the United States, and only three percent of smaller practices.

Two-thirds of the organizations were not financially viable after their initial cash boost—meaning that they couldn't cover their own operating expenses with the payment they received from doctors and hospitals who exchanged information.

In addition, just 13 of the 75 operational RHIOs could conduct the type of information exchange that doctors need to use to receive some of the $30 billion in government incentives set aside to promote health information exchange, the authors report.


Those incentives are part of the U.S. government's drive to increase the use of electronic medical records in general, a practice it hopes will streamline care under healthcare reform.

But as pointed out by the new survey, published in the Annals of Internal Medicine, not everyone has been getting on board quickly.

"One of the challenges in accelerating adoption (of electronic medical records), is that people think of them as just a different way of having a paper chart," Dr. Richard Baron, now at the Center for Medicare and Medicaid Innovation, told Reuters Health.

In reality, "It would be like thinking about Facebook as just a different way to send letters," said Baron, who wrote an editorial accompanying the new research.

As a former doctor at Greenhouse Internists in Philadelphia, Baron described his practice's transition from paper to electronic records.

"It was the most difficult thing we ever did," he said, calling the transition "a very high barrier (that) shouldn't be minimized or underestimated."

But in the year after the practice switched, doctors there began seeing more and more benefits from using electronic records—and smaller costs, Baron said.

Patients have come to expect, he explained, that doctors have all of their medical information available at the click of a mouse.

Yet with the number of hospitals and practices using this technology still low, it's hard for RHIOs to survive, Baron said. After all, he explained, "If you don't have a lot of people practicing with computers, there's not much of a market for people who can move stuff around to other computers."

And without that exchange of information, the health records are only useful for the practice or hospital that created them, and not available to any other doctor the patient might see.

Adler-Milstein said that the survey's results don't reflect what's happened over the last year or more. She suspects that doctors are increasingly starting to demand the services that would help them earn government incentives—giving more life to RHIOs and other efforts that seek to connect providers.


Dr. Anwar Hussain, from UHS Hospitals in Johnson City, New York, said that the potential benefit of sharing electronic medical records is clear.

"We need to make sure that patient safety is not at risk and that we reduce costs by not repeating certain tests," he told Reuters Health.

But Hussain, who also had a perspective piece published in the Annals of Internal Medicine, said that right now, we're rushing to put software in place that hasn't been shown to definitively improve medical care.

That software, he said "really doesn't mirror clinical care"—instead, practices are using software that was designed to help with billing to hold their patient information.

He mentioned one system that requires patients to be "signed in" before doctors can prescribe them medication. That extra step slows down the process of getting drugs to critically ill patients.
"We shouldn't be rushing to implement products that are just not ready," Hussain said.

Adler-Milstein said that while there are some limits to the technology available, what's more important is how doctors choose to use what they have.

Current systems "absolutely have the potential to really meaningfully improve quality, but the systems themselves don't guarantee that that will happen," she said. "Providers are trying to figure out how to use these systems in a meaningful way...I think it's going to be an evolution."