Implementation of Electronic Health Records in US Pediatric Hospitals

More than half of pediatric hospital admissions are associated with chronic conditions, and the increasing prevalence of complex chronic pediatric disorders has, according to researchers, increased the need for tools and systems to facilitate management of information and support clinical decision-making. The researchers recently conducted a survey to assess the rate of adoption of electronic health records (EHRs) and clinical functionalities, participation in health information exchange (HIE), and perceived barriers to as well as facilitators of adoption of EHRs in pediatric hospitals in the United States. They reported survey results in Archives of Pediatrics & Adolescent Medicine [2010;164(12):1145-1151].

The healthcare reform act includes provisions that encourage the adoption and use of health information technology, yet use of comprehensive EHRs is not widespread. Information on use of EHRs in pediatric hospitals is scarce; the only previous national survey (2005) found that 48.6% of pediatric hospitals identified themselves as utilizing EHRs; however, the definition of EHR used in the 2005 survey was not described, creating difficulty in tracking adoption of EHRs in pediatric hospitals and limiting comparisons to other hospitals and health facilities. The definition of EHR used in the current survey was specified by a federally sanctioned panel of experts. The survey was designed to enable researchers to obtain an estimate of EHR use in pediatric hospitals, as well as a basis for comparison with adult hospitals and a baseline for tracking adoption of EHRs by pediatric hospitals over time.

The primary aims of the survey were to determine (1) adoption ranges for specific functionalities, such as omputerized provider order entry (CPOE) and decision support; (2) rates of EHR adoption; and (3) rates of participation in HIE. The survey also assessed hospital characteristics as possible correlates of use of EHRs and outlined the most common barriers to and facilitators of adoption of EHRs. The survey was included as an information technology supplement to the American Hospital Association’s annual member survey. Using a list of general acute children’s hospitals from the National Association of Children’s Hospitals and Related Institutions (NACHRI) membership directory, the researchers identified children’s hospitals among the general survey respondents. A total of 155 general acute care NACHRI hospitals were identified; of these, 69.7% (n=108) responded to the survey. Of the hospitals that responded, 25.9% (n=28) were freestanding, 49.1% were hospitals within hospitals, and 25.0% (n=27) were associate hospitals; 30.6% (n=33) were small (6-399 beds) and the remaining 69.4% (n=75) had ≥400 beds. The majority (82.4%; n=89) were private nonprofit institutions and 74.1% (n=80) were teaching hospitals. These characteristics mirrored the overall makeup of general acute children’s hospitals, according to the researchers.

The survey results found that 2.8% of responding hospitals had a comprehensive EHR system; an additional 17.9% reported use of a basic system. There was wide variation in adoption of individual functionalities. Tests and imaging results viewing was most widespread, with comprehensive implementations of laboratory (99.2%) and radiology reports (99.2%) and of radiology images (95.4%). In 60.6% of hospitals, viewing diagnostic test images (such as electrocardiograms) was present across all units as well as in at least 1 unit in an additional 16.7% of hospitals. Other functionalities commonly in place in all units included drug allergy alerts (61.8%), drug–drug interaction alerts (59.9%), and medication lists (55.7%). However, relatively few hospitals had comprehensive implementation of other functionalities for electronic clinical documentation or decision support. Only 34.4% of hospitals had implemented CPOE for medications in all units. Compared with freestanding hospitals, pediatric hospitals within hospitals had higher rates of implementation for selected key functionalities; none of the comparisons was statistically significant, but the trend was consistent across all of the functionalities included in the survey.

The greatest differences were found in drug dosing support (fully implemented in 51.8% of hospitals within hospitals vs 31.0% of freestanding hospitals) and CPOE for medications (43.5% vs 25.8%). In all, 15.7% of the hospitals reported active participation in HIE outside their own hospital system. Each type of data was exchanged by at least 40% of the hospitals that reported participation in HIE. On bivariate analysis, neither hospital characteristic nor the extent of the use of EHR was associated with involvement in HIE. Barriers to implementation of EHRs cited by the respondents included lack of capital for purchase (56.8%), cost of maintenance (37.6%), lack of interoperability (35.9%), physician resistance (33.2%), and difficulty meeting organizational needs (29.4%). When asked what policy changes would have a positive effect on adoption of EHRs, the hospitals identified additional reimbursement for use (85.8%), financial incentives for implementation (68.6%), technical support for implementation (42.8%), objective EHR evaluations (33.1%), and a list of certified EHR systems (27.8%).