Surprise Finding: The U.S. has More Health IT than Other Countries
It is commonly asserted that the United States lags behind the rest of the world in its use of computerization in health care. [For examples at The Commonwealth Fund website, see Anderson et al. (2006), 2007 testimony by Commonwealth Fund President Karen Davis, and Doolan and Bates (2002).]
This assertion is repeated ad nauseum in spite of the fact that US health care uses computers in all sorts of ways. Computers control advanced medical devices. Private companies use data systems for billing, accounts receivable, claims management, personnel functions, and dispensing prescription medications. Physician groups use computers for many of the same functions. The largest physician groups maintain electronic patient records. Hospitals use computers for all of this and more, including computerized provider order entry (CPOE), clinical guidance, patient records, and electronic prescribing.
In fact, far from lagging behind other countries on health information technology (IT), we are among the world’s leaders.
Unlike many commentators, Jos Aarts and Ross Koppel actually looked at health IT use in the US and other countries. Specifically, they compared the “extent and functionality” of CPOE systems in the US, the UK, Germany, France, the Netherlands, Switzerland, and Austria in a 2009 article in Health Affairs.
Their paper’s introduction seems to repeat the usual meme about the US use of health IT, and those who only read the introduction will be told that:
“the use of CPOE in U.S. hospitals…has been tepid: fewer than one sixth of hospitals of implemented these systems. If full functionality of CPOE systems in included in the criteria for ‘use,’ the percentage of U.S. hospitals with CPOE is even lower. Therefore, we ask: What can the U.S. health care community learn from CPOE use in other advanced Western countries?”
The body of the article tells a rather different story.
The authors find that an estimated 15 percent of US hospitals use CPOE. The US systems usually include direct links to pharmacy systems, decision support systems, links to electronic medical records and electronic medical administration record systems if available.
Only Netherlands has more hospitals using CPOE systems (20%). However, its systems do not have direct links to electronic medical records or electronic medical administration record systems.
Germany has no hospital-wide CPOE systems. There were CPOE systems in only two percent of British hospitals. In France and Austria there are “few” hospital-wide systems. Switzerland has one CPOE, in Geneva.
What does the US have to learn from other countries about health IT? Not as much as they have to learn from us, apparently.
Fascinating post. And a great antidote to all the US health care bashing we see from the Commonwealth Fund.
Ditto. This is really interesting.
So we are not behind the rest of the world afterall. The folks at Commonwealth should be told about this.
Other than government, healthcare was the first area where extensive and early computer installations were made; not only in hospitals but also in areas such as pharmacy application.
And since the 1960’s with the passage of Medicare and Medicaid these systems have constantly been updated and improved. Since “healthcare jargon” and data entries are similar if not exact as they all use standard codes and numbers such as DGR’s, NDC, and ICD’s all these systems are actually fairly complete for most data entries and “connecting” all the various systems together which would assemble all patients records by the common patient ID of Social Security Numbers would do the job fairly quickly and efficiently.
So why did our government fund a $19 billion project to do what has essentially “in place” and wouldn’t take that much to connect these “existing dots”? Don’t look now but a whole extended and non-standard system is being developed that will keep a simple fix impossible!
Art, have you ever heard the phrase “I’m from the government and I’m here to help”?