US lags behind most developed countries in use of electronic medical records but is set to change

BMJ 2010; 341 doi: (Published 01 November 2010) Cite this as: BMJ 2010;341:c6198
  1. Bob Roehr
  1. 1Washington, DC

The United States and Canada lag behind most other developed countries in their use of electronic medical records, a 2009 cross national survey of more than 10 000 primary care doctors has found.

The survey results were presented on 29 October at a briefing for congressional staff in Washington, DC, by the charity the Commonwealth Fund.

Primary care doctors’ access to electronic medical records was “near universal” in the Netherlands (99%), New Zealand (97%), Norway (97%), the United Kingdom (96%), Australia (95%), and Sweden (94%), said Robin Osborn, director of international programmes in health policy and practice at the Commonwealth Fund. Germany (72%) and France (68%) were further down the list, while the US (46%) and Canada (37%) brought up the rear.

However, most of the nations differed in the functionality of their health technologies, some having limited capacity to do things such as order and track laboratory tests, prescribe drugs, identify potentially harmful interactions between drugs, or send follow-up reminders to patients.

The one area where the US does lead is in the proportion of chronically ill people who can access their own medical records online. In the US it is 9%, said Ms Osborn. The next nation is France (4%), followed by the UK (2%), while in Australia, Canada, and New Zealand it is 1%.

Health information technology in the US is a rapidly moving field, with dramatic progress made between 2006 and 2009. Ms Osborn said, “In two or three years the results will be quite different.”

David Blumenthal, the national coordinator for health information technology at the US Department of Health and Human Services, outlined four crucial problems that have to be overcome “with respect to the adoption and functionality of health information systems.”

There has been “a marketplace failure” in terms of the provision of finance to adopt such systems, he said, and a lack of payment rewards “for the higher performance that we expect to see with electronic health systems.”

Secondly, many doctors and hospitals are interested in adopting systems but are “fearful about buying the wrong ones; that they won’t implement it properly; that it may quickly become out of date; and that it may break down when their waiting room is full,” Dr Blumenthal said.

Thirdly, uniform technology standards are not yet in place; nor is there an established infrastructure for information exchange between health technology systems.

Finally, “the American people need to be convinced that the information will be private and secure.”

Dr Blumenthal said that the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed in 2009, had gone a long way towards meeting these needs. It was working quite rapidly “to create a new market for the meaningful use of electronic equipment.”

Tom Bowden, from the company HealthLink, whose electronic patient information system is used by more than 8000 practices throughout Australasia and the Pacific, said that its health information technology had evolved over 15 years through restructuring to focus on primary care and by fostering an environment where government and the private sector worked collaboratively.” He emphasised the importance of involving all stakeholders in the process and “building from the base up.”

Ib Johansen, from MedCom in Denmark, said that its system has grown along the same principles. He told the BMJ that it is easier to implement such changes in a small nation, where all speak the same language and share a common culture, than in the US, with its diversity and more than 300 million people.


Cite this as: BMJ 2010;341:c6198

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