Across the country, some healthcare systems have been slower to adopt electronic health record (EHR) systems than others.
But a new report in an online edition of the journal Health Affairs indicates that as of 2008, hospitals that treat the largest share of poor patients are less likely to have adopted IT systems than other facilities, a factor that may expand disparities of care in a new way: the so-called "digital divide."
"Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic medical records," the authors said. "These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap."
Electronic systems, such as computerized provider order entry for tests or medications, are widely believed to improve efficiency, quality, and accuracy of care as well as reduce redundancies.
The authors added, "These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients."
Unfortunately, some wide gaps exist between those hospitals that treat large numbers of the poor and those that don't.
The survey, presented in the form of a questionnaire in partnership with the American Hospital Association, was sent to chief executive officers of 3,747 acute care non-federal hospitals. A total of 2,368, or 63.1%, of the CEOs responded to the survey.
The report divided EHR functions into 24 categories of clinical application, such as whether the system recorded demographic characteristics, medication lists, nursing assessments, physician notes, discharge summaries, and advance directives.
Hospitals were separated into four categories depending on how many poor people they treated, as indicated in a federal "disproportionate share" (DSH) index.
"High-DSH hospitals had lower rates of adoption of all 24 compared to low-DSH hospitals, although the magnitude of the gap varied greatly and not all differences were statistically significant," the report said.
But some were very significant. For example, of those hospitals treating the highest numbers of the poor, those in the first quartile, 27% have bar coding for medication administration whereas 41% of hospitals that treat the lowest numbers of the poor, those in the fourth quartile, had the bar code system.
For electronic clinical documentation of medication lists, 62% of high-DSH hospitals had such a system in place compared with 74% of low-DSH hospitals.
Asked what impediments to adopting EHR prevented them from doing so, the biggest reason given was inadequate funding, although high-DSH hospitals were more likely to give that as a reason than low-DSH hospitals.
Other concerns include the return on investment, cost of maintenance, resistance from physicians, and concerns about lack of future support.
Through the American Recovery and Reinvestment Act of 2009, the federal government is earmarking $30 billion to establish a national health IT infrastructure that uses financial incentives through Medicare and Medicaid to promote EHR by hospitals and physicians.
"Although there is broad support for helping healthcare providers adopt EHRs, some worry that such efforts might exacerbate existing disparities in care by creating a new healthcare 'digital divide' between providers that disproportionately care for the poor and those that do not," the authors said.
They pointed to the need to address a "central policy question" about whether the ARRA will be used to reduce this gap.
"Given the potential of EHRs to improve the efficiency and effectiveness of care, these providers' ability to furnish high-quality healthcare may be further compromised if they lag in EHR adoption."
The report was authored by Ashish Jha, associate professor of the Harvard School of Public Health in Boston and colleagues at Massachusetts General Hospital's Institute for Health Policy; the Harvard/MGH Center for Genomics, Vulnerable Populations and Health Disparities; and George Washington University in Washington, D.C.