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Comparative Analysis of Health IT Adoption Worldwide

This study compares the adoption of health information technology across nations, highlighting the challenges, opportunities, and implications. Through surveys and expert insights, it explores the current landscape and future prospects of HIT.

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Comparative Analysis of Health IT Adoption Worldwide

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  1. Health IT Adoption: A cross-national comparison Ashish K. Jha, MD, MPH Harvard School of Public Health Brigham and Women’s Hospital VA Boston Healthcare System June 26, 2006 Funded by: The Commonwealth Fund, New York, NY

  2. Background • Healthcare costs rising in many nations • Quality of care variable, often inadequate • The promise of health information technology • Will increase quality • Will improve efficiency • Will improve coordination of healthcare • Despite major policy focus • Level of HIT adoption in the U.S. unknown • How U.S. compares to other nations also unknown

  3. Research Questions • What is the level of HIT adoption in the U.S.? • How does it compare to other nations? • What are the major programs currently in HIE?

  4. Methods • A comprehensive review of U.S. surveys • Rating of surveys based on methodology, content • Ratings criteria developed by group of experts: • Sampling technique, response rate • EHR content • Reviews of surveys from other nations • Interviews from experts

  5. Results • Health IT in the U.S. • 35 surveys of physicians and other providers • 21 surveys available for rating • 16 surveys of EHR adoption in ambulatory care • 5 surveys of EHR adoption in inpatient care • Few surveys of high quality • Nine high quality in methodology • Eight high quality in EHR content • Four surveys high quality in both areas

  6. Results – U.S. EHR adoption

  7. Cross-national comparison

  8. Health Information Exchange

  9. Discussion • U.S. adoption rates of EHR low • Lack of good estimates • Less than 1 in 5 ambulatory physicians using EHR • Approximately 1 in 20 hospitals using CPOE • Other nations ahead on ambulatory EHR • U.S. has lowest rate of EHR use in ambulatory care • Substantially behind Australia, UK, NZ and Netherlands • Lack of high quality data make other assessments difficult

  10. Discussion • Poor adoption rates in hospitals • No nation has moved substantially in this area • Different levels of activity on data exchange • Major efforts in UK, Canada, and Netherlands • Slower efforts in US, Australia, and NZ • Even well touted programs running into obstacles

  11. Limitations • Important caveats to adoption data • U.S. estimates based on few high quality surveys • Large confidence intervals when other surveys included • Data from other nations not rigorously evaluated • Most surveys don’t distinguish “have” from “use” • Field rapidly changing

  12. Implications • Health IT adoption varies across nations • U.S. behind in ambulatory EHR use • Likely will need greater access to capital to improve • IT in hospitals widely neglected • Best evidence for improving care • New efforts to focus on hospital IT • HIE very early in deployment • No single approach will work for all nations • Adequate funding just part of the challenge

  13. Acknowledgement • HIT Adoption Initiative – funded by ONC • Tim Ferris • Karen Donelan • Alex Shields • Cait DerRoches • Sara Rosenbaum • David Blumenthal • Cross-country Initiative – funded by CMWF • Doreen Neville • Tim Clark • David Doolan • David Bates

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