Upfront

Electronic health records haven't lived up to their billing as a cost saver due in part to health professionals' slow adoption of technology and to difficult-to-use health IT systems that don't easily communicate with one another, say researchers in a Health Affairs analysis.

In 2005, a research team from the RAND Corp. projected that the U.S. health-care system could save more than $81 billion a year if providers rapidly implemented electronic health records. The study generated controversy: While the information technology industry enthusiastically supported the findings, the Congressional Budget Office said the savings figure was overly optimistic.

The latest analysis, by other RAND researchers, reports that more providers now use health IT than in 2005, but the quality and efficiency of patient care have improved only marginally and annual health-care spending has increased since then, from $2 trillion to $2.8 trillion. However, the annual rate of increase declined, from 6.8 percent in 2005 to 3.9 percent in 2011, according to the Centers for Medicare and Medicaid Services.

About 40 percent of physicians and 27 percent of hospitals in the United States use at least a basic electronic health record, the study says. No hard numbers are available on how many psychologists use health IT. Although APA endorses the use of interoperative electronic health records to facilitate more integrated care in the United States, psychologists are still on the sidelines of health IT adoption, says Stacey Larson, PsyD, JD, APA's director of legal and regulatory affairs. Some psychologists say they haven't embraced health IT due to the high cost of implementing it, while others say they are concerned the systems could compromise patient confidentiality, Larson says.

For now, psychologists are more likely to use electronic management software than electronic health records, says Nathan Tatro, project manager for practice research and policy in APA's Practice Directorate. Management software can help reduce paper files and organize electronic documents, but it doesn't have interoperability — the capacity to make records available to other providers, health-care facilities and patients.

In fact, most of the health IT systems on the market "are not designed to talk to each other," say RAND researchers Arthur Kellerman, MD, and Spencer Jones, PhD, authors of the Health Affairs analysis. Health IT systems can also be difficult to use, and manufacturers have a long way to go in designing affordable, easy-to-use health IT that's interoperable, say Kellerman and Jones. But to maximize health IT's potential benefits, they add that providers can play an active role by "re-engineering" how they provide care to facilitate teamwork.

For psychologists, that could mean writing progress notes in less technical language for other providers who are treating the same patient, Larson explains. "A cardiologist who wants to remain informed of and understand his patient's behavioral health history wants to be able to easily and quickly ascertain a psychologist's diagnosis without having to decipher what certain mental health terms mean," she says.

—Rebecca Voelker