Most experts agree that the use of health information technology (HIT) could lead to a safer, more efficient health care system, but there remain key challenges and barriers to achieving widespread HIT adoption, including the Bush Administration target of 2014 for nationwide adoption of electronic medical records. Dr. Rainu Kaushal and colleagues have been examining these challenges as part of an Information Technology Working Group launched by the Harvard Interfaculty Program in 2002. Prompted by the agenda for improvement articulated in the IOM Report Crossing the Quality Chasm, the group came together to explore opportunities for bridging the chasm of clinical IT by delineating infrastructure and framework standards, documenting the current state of clinical IT in two major markets, and highlighting the financial, policy, and organizational changes needed to bridge the divide. As a result of these efforts, members of the Working Group, together with other HIT experts across the Harvard faculty have published findings from three studies examining the costs of a National Health Information Network (NHIN), what it would take to get there in five years, and what is blocking wider adoption of HIT.

In an August 2005 Annals of Internal Medicine article, Kaushal and colleagues estimated that a NIHN would cost $156 billion over five years. "This is not a drop in the bucket, but when you put it in the context of overall health care spending, it is not overwhelming," says Dr. Kaushal. Another big concern, she says, is figuring out who will benefit from implementation and uncertainty about the return on investment. Given that institutions tend to invest in things that offer direct financial benefits, she questions whether the private sector will rapidly adopt IT without significant help from the public sector – both in terms of money and leadership. "The one area where we still need to invest effort is to try and figure out how much HIT costs, who bears those costs, how they will bear those costs, and how will those costs be absorbed by rural and underserved communities." An abstract of the Annals article is available here.

Critical to making progress on financing and the existing investment gap is the need for better information on the current level of HIT adoption. In response to this need, Eric G. Poon, Rainu Kaushal, and others performed a baseline assessment of HIT adoption in the United States across eight key sectors of the health care system. The results of this assessment are reported in a recent article in BMC Medical Informatics and Decision Making, available on the BioMed Central website. They found that despite growing interest in HIT, adoption remains limited, especially in ambulatory electronic health records and physician-patient communications. Physician practices, in particular, face enormous financial challenges in adopting HIT. Kaushal predicts that adoption will continue to drag without significant financial resources. In a September/October 2005 Health Affairs article, Kaushal and colleagues say policymakers should worry about inequities in quality-related benefits that could occur if large stakeholders such as hospitals rapidly advance in HIT adoption and smaller stakeholders continue to lag behind.  The government needs to push policies directed at advancing adoption by smaller stakeholders and underserved and rural communities to prevent a digital divide, she says.

Working with Kaushal and others, PHSI director David Blumenthal is leading a multi-disciplinary research team to examine the state of HIT adoption under a contract from the federal government under David Brailer and with support from the Robert Wood Johnson Foundation. Blumenthal is partnering with Brigham & Women's Hospital, Partners HealthCare, and the George Washington University School of Public Health and Health Services.