Majority of Children's Hospitals Not Set Up for Electronic Health Records

Nancy Fowler Larson

December 06, 2010

December 6, 2010 — Most pediatric hospitals lack even the minimum setup needed to keep good electronic health records (EHRs), citing cost as the chief deterrent, according to a study published in the December issue of the Archives of Pediatric & Adolescent Medicine.

EHRs are growing in importance as chronic conditions such as asthma, obesity, and behavioral disorders emerge as the primary reasons for children's hospitalizations. Easily obtainable knowledge about patients' prior treatment is advantageous in managing these conditions, but such data are in short supply.

"Information on EHR adoption specifically by children's hospitals is scarce," write Mari Nakamura, MD, MPH, from the Department of Medicine and the Information Services Department, Children's Hospital Boston, in Massachusetts, and colleagues. "These data are of interest, however, because children's hospitals treat more than 1 million, or about one-third, of pediatric inpatients annually and provide most of the care to children with complex conditions."

Using an EHR definition set by a federally sanctioned expert panel, the investigators sent surveys to 155 hospitals in 2008. Of the 108 that responded, 25.9% were freestanding institutions, 49.1% were "hospitals within a hospital," and the rest were associate facilities; 82.4% were nonprofit institutions, and 74.1% were major teaching hospitals.

The researchers sought data in three areas: the rate of use and support for 32 specific functionalities such as computerized provider order entry, EHR implementation rates, and the facilities' degree of health information exchange sharing.

Less Than 3% Have Comprehensive EHR

Among other findings, the study revealed that less than 18% of hospitals had basic EHR systems, and even fewer had comprehensive operations, as follows:

  • 2.8% (95% confidence interval [CI], 0% - 6.0%) had EHR throughout the hospital;

  • 17.9 (95% CI, 10.4% - 25.3%) had a minimal setup in at least 1 unit;

  • 34.3% were using computerized provider order entry for at least medications in every unit; and

  • 14.7% shared health data electronically outside their own system.

In comparison, previous studies show that only 1.5% of adult hospitals have comprehensive EHR, and just 7.6% have minimal systems.

With regard to the children's hospitals in this study, financial reasons were most often cited for a lack of EHR.

"The 2 most common barriers to EHR adoption identified by children's hospitals were inadequate capital for purchase and maintenance cost," the authors write. "Correspondingly, the most frequently cited facilitators were reimbursement for EHR use and financial incentives for implementation."

The investigators noted several limitations to their study, as listed:

  • responding institutions were primarily teaching hospitals, which are already likely to have more EHR capabilities;

  • there was no determination of EHR system effectiveness; and

  • the study's power was decreased because of a dearth of children's hospitals in the United States and the small incidence of EHRs within those that exist.

The federal government is pushing expansion of EHR systems in adult and children's medical facilities, but state budget-cutting may interfere with that effort.

"Furthermore, cuts by state governments to Medicaid and the state Children's Health Insurance Program, both vital funding sources for children's hospitals, threaten to offset federal incentives for EHR implementation," the authors write. "As we devote efforts and invest financial resources toward expanding use of EHR systems, we must ensure that children's hospitals, and the patients they care for, are not left behind."

Harvard Medical School, Harvard Pilgrim Health Care, the Department of Health and Human Services, and the Robert Wood Johnson Foundation supported the study. Dr. Ashish Jha has received consulting fees from UpToDate, Inc, and serves on the Scientific Advisory Board for the Humedica company. The other study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164(12):1145-1151.

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