Technology Review
Stimulus funds aim to change a system largely devoid of in-depth electronic record keeping.
Less than 2 percent of U.S. hospitals today use comprehensive electronic health records, according to a new survey of 3,000 hospitals that highlights just how far the health-care system has to go to meet President Obama's goal of providing every American with access to electronic records by 2014.
Experts involved in the study, headed by David Blumenthal, Obama's newly appointed national coordinator for health information technology, say that the $19 billion in funding for health-care information technology and other provisions outlined in the new stimulus bill will directly address the two major hurdles to adoption--the cost to implement and maintain the records, and the difficulty of exchanging information among various health-care providers' differing computer systems.
"Those provisions try as directly as possible to address some of the barriers highlighted in the research," said Blumenthal, a physician who currently serves as the director of the Institute for Health Policy at Massachusetts General Hospital (MGH) in Boston, at a press conference this week. He will assume his new post in April, leading an office within the Department of Health and Human Services--the Office of the National Coordinator of Health Information Technology--which was made permanent by the stimulus legislation.
According to the findings, published Wednesday in the Journal of the American Medical Association, about 8 percent of U.S. hospitals use basic EHR systems--which include patient demographics, medical complaints, medications, and some test results--in at least one department. Only about a quarter of those are using comprehensive EHR systems, including so-called decision support systems, which assist physicians and other health-care providers in making treatment decisions, for example, reminding them to prescribe pre-operative antibiotics.
"If the goal of [electronic record] adoption is to improve quality of care, then this kind of decision support can help clinicians provide the right care more often," said Cait DesRoches, a public health expert at the Institute for Health Policy at MGH and one of the authors of the study, at the press conference.
Individual electronic functions are more common--about 16 percent of hospitals use electronic ordering systems for medications, while more than three-quarters of respondents reported using electronic systems for the results of laboratory and radiology tests.
Amid a growing emphasis on electronic health records, one patient tests online health services.
Open programs to third-party developers, say two tech-savvy physicians.
I agree standards are key - as a former hospital CIO I know - how many different ways are there to write in a patient's chart "high blood pressure" - I can think of 4 in a matter of seconds. Imagine the internet with without HTTP or WWW as "standards".
The truth is that it is not just standards but a major cultural change akin to changing GM from a car/tuck company to a nanotech company. The issue is multifaceted not just standards, but dollars, outsource vs in-house, open source vs proprietary, etc. Look the the Department of Veterans' Affairs and their EMR system called VISTA about 10 years old and extremely well received and has driven massive costs out of their system across the country in over 180 hospitals and clinics. Last info I remember was that as of about 2006 they had a cost increase of less than 6% (total)over 10 years and the majority of the savings was due to the EMR system.
And this does not even touch the homeland security perspective issue for a public health event. Look to Katrina and Tulane Medical center losing millions of hours of research while the VA hospitals in the area that got flooded lost nothing due to the Vista EMR and backup systems.
Bottom line without federal intervention to force standards and use of EMR interoperable systems we will continue along this backward way of practicing medicine while costs continue to rise.
This study is fatally flawed. It used a definition of electronic record as a complete and fully integrated/connected record that only a few harvard-affiliated and other major medical centers could lay claim to. It is analogous to saying no one uses interstate highways because every home's driveway doesn't have an easy on-ramp.
thousands of smaller hospitals/office practices have a functional (for their purposes) electronic record, and they have capability to share it with other providers (at their discretion). Even within the model VA Health System not all providers are able to see all patients records across every (VISN) network.
Further, the true electronic record innovators mostly work "offline" from the fully-integrated record so their enhanced systems and prototypes likewise would not show up as "adopted" within this study.
Next time, ask for the "degree" or "percent" of information captured in the EHR if you want the true measure.
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DeltaDude
2 Comments
Hospital Electronic Wastland
I don't see how you can even start such a project without worldwide agreement on file formats. Getting world wide agreement & clearly defining data fields and what goes in them may also be a major challenge.
Just thinking about this gives me a major headache.
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