U.S. lags the world's top adopters of electronic health records systems

Report urges the government to adopt Scandinavian policies to increase use of the systems, but acknowledges the task here will be greater.

The United States is far behind countries that lead the world in using electronic health records, and the nation should borrow some of their policies to increase the adoption rate of e-health records here, according to a report a technology advocacy group released on Wednesday.

In its report, the nonpartisan think tank Information Technology and Innovation Foundation said the United States lags Denmark, Sweden and Finland in adopting electronic health records. For example, all primary care physicians in Sweden use electronic health records, while the rate is 99 percent in Finland and 95 percent in Denmark. Only 28 percent of primary care physicians in the United States use electronic health records, the foundation reported.

The rates in Denmark and Finland are high because the countries started pushing the use of the records in 1994 and 1996, respectively, years before the United States began using the systems.

But policies also spurred the adoption of the systems, including those that encouraged the use of electronic prescriptions. In Denmark, 100 percent of primary care physicians use an e-prescribing system, a result of a government mandate. Daniel Castro, senior analyst at the foundation and author of the report, said he viewed adoption of e-prescribing in this country as one of the core technologies of a national health IT system.

Denmark also requires primary care providers to issue patient referrals to specialists electronically and to maintain standardized clinical records. In Finland, the government passed a law that requires public and private health care providers to adopt a national patient record system by April 2011.

The United States has issued mandates for health IT only in a few cases for limited technical changes rather than as a push for broad reform, according to the report. The Obama administration intends to use $1 billion in stimulus payments under the Recovery Act to encourage adoption of health IT technologies in the United States, including payments of up to $41,000 to doctors who use e-health systems.

Denmark and Finland also have invested in a robust health IT infrastructure, including Web-based e-health portals, which in the case of Denmark, allow electronic communications between patients and health care providers. The foundation's report recommended the United States develop health record data banks where patients could access and manage their records through a single portal.

Although the United States is following a decentralized approach to the adoption of health IT, the foundation recommended policymakers support the development of a common infrastructure for routine tasks, such as a system for electronic patient authentications.

The report also concluded that the smaller Scandinavian countries have helped them lead the world in the development of national health IT systems. Fewer health care providers, patients and other stakeholders make it easier to coordinate among the groups.

That's what health officials found in New Zealand, where the challenge of hooking up 3,000 primary care physicians and 22 hospitals is far easier than developing systems for 1.5 million doctors and 5,700 hospitals in the United States, said Dr. Chris Hobson, chief medical officer of Orion Health, a health IT software company in Auckland, New Zealand. "Small is definitely easier," he said.

Orion has learned other lessons, besides the challenges of size, from installing health systems in New Zealand, Australia and Canada that also can apply to the United States. A national network is essential because the exchange of data between doctors is required to provide quality health care, Hobson said.

He said a common patient identifier should be part of the national system, and he recommended that e-prescribing systems include software that alerts clinicians to potentially hazardous drug interactions. The foundation recommended adoption of a national machine-readable patient ID card, which it said could save the government $1 billion a year in administrative costs.