Why Is The U.S. Lagging in EHR Adoption?

In 2012, nearly two-thirds of primary care physicians in the United States used an EHR, up from 46% in 2009. That’s an impressive uptick considering the timeframe. But when compared to the EHR adoption rates of other highly developed countries, the U.S. still resides towards the back of the pack.

Included amongst the countries above the U.S. in terms of countrywide EHR adoption rates are the Netherlands at 98%, the U.K. at 97%, Australia at 92%, and New Zealand at 97%. For a country as innovative and technologically advanced as the U.S., this gap is surprising.

Why is the EHR adoption rate in the U.S. lagging behind that of these other highly developed nations?

Unifying Organizations
The Office of the National Coordinator for Information Technology (ONC) was created in 2004 by Executive Order, but it wasn’t legislatively mandated until the HITECH Act was passed in 2009. The act granted the ONC $2 billion and made it responsible for the creation of a Nationwide Health Information Network.

The act transformed the ONC into a powerful unifying organization, or driving force, responsible for boosting the adoption of health IT in the U.S. Initiatives like the Medicare and Medicaid EHR Incentive Programs are its attempts at doing so. It’s no coincidence that the U.S. has seen such a large jump in the EHR adoption rate since 2009.

Many of the higher-ranking countries already had their unifying organizations firmly entrenched prior to 2009. A 2007 study published in Healthcare Quarterly concluded that centralized government policies spurred the acceptance of health IT by physicians in countries like the U.K. and Germany, while non-government entities in New Zealand and Denmark were driving acceptance.

Unique Patient Identifiers (UPIs)
A report by the Information Technology and Innovation Foundation discovered that countries with national UPIs, such as Denmark, Finland, and New Zealand, are also considered leaders in health IT on a global scale. This leadership is bolstered by their high EHR adoption rates. Conversely, the U.S. doesn’t utilize a national UPI and also has the lowest EHR adoption rate among these developed nations.

This makes sense because one of the most touted benefits of EHRs (and what differentiates it from EMRs) is interoperability. UPIs help make the location and identification process of patients across various EHRs run more smoothly. Without a national UPI, it’s harder for physicians to realize the full benefits of EHRs, creating yet another barrier to near-universal adoption

Country Size
One common characteristic of the countries with higher EHR adoption rates is their comparably small size, either in population, area, or both. Of the countries with adoption rates higher than the U.S., Germany is the most populous with over 81 million people, while Australia outranks the group in area, coming in at over 2.9 million square miles. Meanwhile, the U.S. boasts over 300 million people and 9.6 million square miles.

In the U.S., EHR adoption has to spread to more physicians over a larger geographic area, meaning different norms and ways of life often inhibit near-universal adoption. Yes, the countries with higher EHR adoption rates face some of these cultural barriers as well, but it is nevertheless on a much smaller scale than in the U.S.

As the U.S. becomes increasingly more health IT-friendly, the EHR adoption rate will continue to rise. And if it’s anything similar to the last three years, the U.S. will soon be right there with the Denmarks and Finland of the world, resulting in a better healthcare industry for both physicians and patients.

If you’re part of the one-third of U.S. physicians not currently using an EHR, check out our EHR Buying Guide.

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