EHR use is greatest at multidisciplinary practices with more than 50 doctors, Handler says. At smaller clinics the adoption rate is between 5 percent and 10 percent, he says, adding that 75 percent of U.S. physicians practice in groups of five or fewer doctors.
As smaller practices merge, Handler sees the EHR adoption rate rising, but "100 percent EHR adoption could be another decade."
Most providers are familiarizing themselves with EHRs but only a few organizations are delving into data projects, said Jed Weissberg, senior vice president, hospitals, quality and care delivery excellence and a doctor at Kaiser Permanente, a 9 million-member health plan and care provider in Oakland, California. "The rest of American medicine is getting on the platform and getting up to speed."
But incorporating EHRs into health care does not automatically translate into robust data analysis. IT vendors, hospital executives and physicians pose unique challenges to getting big data into medicine.
Core EHRs "are still mainly used for documentation of individual patient visits and don't contain all the data you might like," Weissberg said.
At Kaiser, which completed rolling out its Epic Systems-powered EHR system, Kaiser Permanente HealthConnect, to its 37 hospitals and 533 medical offices in 2010, EHRs lacked the ability to capture pain and functionality data on patients who had joint surgery, for instance. Post-surgery metrics could be placed in a database that could help potential joint surgery patients learn how people with similar clinical conditions benefited from the operation.
Kaiser will start capturing this data and is looking into having patients enter this information via a secure Web portal or having a physician assistant handle the task with a tablet during the follow-up visit.
"Everybody wants this approach to big data and more advanced analytics to work," Weissberg said, noting that querying a database to research unique medical conditions is cheaper and faster than launching a research study.
Personalized medicine usually entails talk of genomics, but EHRs and data mining can also lead to tailored care, he said.
"Starting with overall population we can define subsets by age, gender, clinical conditions and body mass index that are enough like you. We have enough data that we can at least show what happened to them."
For now, EHR functionality is limited to what developers build into the software, said Ramy Arnaout, a pathologist and associate director of the clinical microbiology laboratory at Beth Israel Deaconess Medical Center in Boston, noting that his views are his own and don't necessarily reflect those of his employer.
"If they don't build software that lets you mine data in the kind of ways that you're suggesting then you're largely out of luck," he said.
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