Wednesday, February 27, 2008
Electronic Health Record - tick tock, tick tock
Go into most doctor's offices or clinics across the United States and you will see racks of messy files, patient charts, stacks of paper ready to be filed and lots of little messages and bits of paper that have no home. You could not differentiate if it is a chart room from 1943 or 2008, except that now there is 20 times the paper to be filed.
There is unanimous agreement from doctors, hospitals, patients, academics and Yes! our own government that Medicine is far behind other industries in automating with an electronic health record (EHR aka: electronic medical record). The push for the EHR has been around for 10+ years, continuing today from Pres. Bush and each of the presidential candidates in their "reform health care" platforms. Despite the unanimity around the benefits to society with a universal EHR, only 14% of doctors use a "minimally functional" EHR...one that captures clinical notes, orders for prescriptions, lab and radiology tests and results.
Roughly half of all practicing physicians are in solo or small partnership practices. They don't have the resources, IT infrastructure, or development time to convert to the electronic health record. Large multi specialty groups (10 doctors or more) are the ones that are adopting this technology and generally they are very happy with the benefits to their practice lives and their patient care.
So when you hear the candidates talking about linking doctors, hospitals, all caregivers and patients electronically through an EHR and the wonderful savings that will be obtained by technology you should ask "Oh, yea, how do you think this is going to happen?" Despite billions of dollars invested in software development, we still do not have an interoperable EHR. The systems don't talk to each other and the vendors are competitors and are unwilling to interface with each other.
A personal health record that the patient keeps is one thing and is valuable for both self-responsibility and control. But that is very different from a real time, complete, instantly accessible electronic chart that can be used by each of your doctors, whether it be the ER or the dermatologist. The privacy issues will disappear if we truly think of what is needed for best patient care (not data mining so you can be sold something or denied coverage for a condition).
Over time (lots of time), I think we will get there. The solo practitioner is a dying practice model and Medicine is going the way of big business and larger groups. It will take this type of capital investment for the EHR to be implemented everywhere. Making sure our technology goals have the "patient first" will go a long way in speeding up the process.
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