Correspondence

Meaningful Use of Health Information Technology in U.S. Hospitals

N Engl J Med 2010; 362:1153-1155March 25, 2010

Article

To the Editor:

In April 2009, using a definition of electronic health records that was based on expert consensus, we described the small number of acute care hospitals in the United States that had these systems.1 Since that time, the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services has announced a notice of proposed rulemaking to implement provisions of the American Recovery and Reinvestment Act of 2009; these provisions include incentive payments for the “meaningful use” of certified electronic health record technology.2

In its proposed standard of meaningful use, the CMS uses a 5-year, three-stage, phase-in process focusing on health care quality, safety, and efficiency. This overall focus is refined into certain specified functionalities beginning in stage 1, which involves electronically capturing health information in a coded format, using information to track key clinical conditions, communicating that information for the coordination of care, implementing clinical-decision support tools to facilitate disease and medication management, and reporting clinical quality measures and public health information. The Office of the National Coordinator for Health Information Technology, the director of which was a coauthor of the April 2009 article,1 has further categorized these functionalities into five specific health policy priorities: improving quality, safety, and efficiency; improving patient access to care; improving care coordination; improving public health; and ensuring sufficient privacy and security protections for personal health insurance.

Using data from our 2008 survey of health information technology in acute care hospitals in the United States,1 we estimated the proportion of hospitals with the necessary information-technology systems to achieve meaningful use during stage 1 in each of the policy priority areas defined by the CMS. The details of the methods are reported elsewhere1; however, our survey did not include items to assess two of the information-technology objectives of the CMS: protection of patient privacy and data security and maintenance of electronic records of smoking status.

As shown in Table 1Table 1Characteristics of Acute Care Hospitals That Met Functionality Criteria in Each Policy Priority Area., a minority of hospitals had the necessary information-technology systems to achieve meaningful use in any of the areas defined by the CMS. Approximately 14.2% of U.S. acute care hospitals had the necessary systems for improving public health, 11.0% had the necessary systems for improving care coordination, 7.8% met the requirements for improving patient access, and 2.5% met the functionality requirements for improving quality, safety, and efficiency. Only one hospital met the criteria in all four areas. Larger hospitals and those located in urban areas were more likely to have fully implemented the systems necessary to achieve meaningful use in each of the four policy priority areas.

The very low levels of adoption of the key health-information-technology systems required for meaningful use suggest that hospitals face substantial obstacles to achieving the level of use required to receive federal incentive payments. However, many hospitals had some, but not all, of the necessary functions. This finding suggests a very specific need among hospitals for technological support to integrate new systems with their existing systems to meet the meaningful-use objectives of the Office of the National Coordinator for Health Information Technology. The regional extension centers funded by this organization should play an important role in this area.

Catherine M. DesRoches, Dr.Ph.
Harvard Medical School, Boston, MA
cdesroches@partners.org

Sara J. Rosenbaum, J.D.
George Washington University Medical Center, Washington, DC

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

2 References

1
Jha AK, DesRoches CM, Campbell EG, et al. Use of electronic health records in U.S. hospitals. N Engl J Med 2009;360:1628-1638
Full Text | Web of Science | Medline

2
Centers for Medicare & Medicaid Services. Medicare and Medicaid programs: electronic health record incentive program: proposed rule. Fed Regist 2010;75(8):1843-2011. (Also available at http://edocket.access.gpo.gov/2010/E9-31217.htm.)

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