Thursday, March 26, 2009
Electronic Health Record - Don't Hold Your Breath
The New England Journal of Medicine study that shows less than 2% of U.S. hospitals have a comprehensive electronic record is being discussed all over the news.
The benefits of going electronic, getting rid of wasteful paper, and providing all caregivers with the right information to care for patients has been proven time and time again. We can go to the moon. We can log onto Amazon and be recognized personally for our reading habits. We can have 6000 friends on Facebook. We can share our every thought on Twitter. So why are we stuck doing medicine like we did in 1950?
Here are some reasons why this is so damn hard.
Electronic health records, where physicians and caregivers can document, write notes, see information real time, do assessments and orders for patients, require millions of dollars in capital to develop and install. Seventy four percent of hospitals reported inadequate capital and 44% couldn't afford the maintenance costs.
Another barrier is the fact that electronic records systems are not interoperable. Imagine installing a $100 million dollar system that doesn't talk to anyone outside of the hospital. Patients are mobile. They go from physicians office to hospital to clinic to lab...and that is just within their own town. If the electronics cannot communicate, information is incomplete and possibly even dangerous.
One cannot underestimate the training and maintenance costs that accompany "going electronic". Think how you feel when your computer crashes or freezes or slows down. Hospitals need to build fire walls, redundancies, back-ups, plan for disasters. Systems need continual upgrades and all staff needs to have training and support. You can't shut down patient care while this is going on so you need to bring in extra staff for weeks while you are transitioning from paper to computers. Training and "help desk" expertise is an ongoing expense. Hospitals that do not have Information Technology specialists on staff will need to develop an entire department of hundreds of new experts.
Hospitals develop business plans for capital expenditures and look for a ROI. A third of hospitals surveyed did not believe they would recoup their investment in eHR.
These findings are sobering. We absolutely have to join the digital age and use technology and decision tools to improve quality, reduce error and become more efficient.
Posted by Toni Brayer, MD at 9:22 AM