A survey by the American Hospital Association of nearly 1,000 community hospitals in the US has revealed that only 10% have fully-implemented IT systems with electronic health records and reporting, with technology being mainly concentrated around urban areas and in teaching hospitals.

The study, ‘Forward Momentum: Hospital Use of Information Technology’ [PDF, 632K] found that 82% of those "not even considering" implementing IT systems were rurally located. Only 1% of those questioned who had no IT plans were teaching hospitals.

Asked to gauge their level of IT use 10% of rural hospitals described it as high, equating to implementing almost all of the functions of an Electronic Health Record. Another 36% said they were getting, 27% said it was low and the same number said moderate.

The smallest hospitals, with fewer than 50 beds, were found to be almost 10 times more likely to be in the getting started group than the largest ones – more than 500 beds. For hospitals in urban areas, almost 50% had moderate or high use of IT.

Among the hospitals surveyed the median amounts spent on IT in the last financial year was approximately $700,000 in capital spending, or 1.5% of capital expenses; $1.7 million in operating costs, or 2% of operating expenses.

George Lynn, chair of the AHA, said that "major investment in IT from both the public and private sector" was needed, along with "a common set of standards so different computer systems can talk to one another."

The most popular use of IT in hospitals was laboratory result viewing, with 64% of hospitals saying they had fully implemented technology in this area, with 30% with fully-implemented electronic health records and 41% with PACS.

The survey examined the different levels of electronic health records and systems being used. While the majority of hospitals had order entry and patient demographics systems in place, 2% said they had patient support with home-monitoring. 30% of hospitals had physicians using PDAs, and around half of hospitals in both rural and urban areas were using some kind of telemedicine.

According to the AHA, IT implementation must be an evolutionary procedure. "Given the large-scale changes – and large-scale costs – of these kinds of systems, many hospitals are taking an incremental approach. For example, they may implement IT systems in individual departments, working over time to connect them."

In the hospitals that had IT system, nurses tended to use them more than other clinical or administrative staff; 45% of hospitals had nearly all of its nurses using IT functions, compared to 19% of hospitals with highly-connected physicians.

One of the striking results of the survey is it finding that in 19% of rural hospitals "no physicians use IT functions", and in 17% "no nurses use IT functions".

"While hospitals have been pioneers in harnessing IT to improve patient care, quality and efficiency, the challenge is to extend its use and integrate it into routine care processes in all hospitals, big and small, in both rural and urban areas," says the survey.