EHRs and investment deficit disorder

Just read a comprehensive, well-researched, thought-provoking article in the New York Times about the global economic crisis and the tasks facing Barack Obama as he tries to turn the US around. Smack dab in the middle of it was, of all things, a reference to electronic health records:

“One good way to understand the current growth slowdown is to think of the debt-fueled consumer-spending spree of the past 20 years as a symbol of an even larger problem. As a country we have been spending too much on the present and not enough on the future. We have been consuming rather than investing. We’re suffering from investment-deficit disorder.

“You can find examples of this disorder in just about any realm of American life. Walk into a doctor’s office and you will be asked to fill out a long form with the most basic kinds of information that you have provided dozens of times before. Walk into a doctor’s office in many other rich countries and that information — as well as your medical history — will be stored in computers. These electronic records not only reduce hassle; they also reduce medical errors. Americans cannot avail themselves of this innovation despite the fact that the United States spends far more on health care, per person, than any other country. We are spending our money to consume medical treatments, many of which have only marginal health benefits, rather than to invest it in ways that would eventually have far broader benefits.”

Sadly, Australia is not one of those “rich countries” referred to in the article; our progess toward implementing electronic health initiatives is far behind even the US…

There is also a discussion on how the US spends too much on medical treatments that don’t work particularly well (trouble ahead for the pharma industry). The whole article is well worth reading:


EMR penetration not as good as it looks

Ken Terry writes on BNET Healthcare: “The latest news on electronic medical record (EMR) penetration in physician practices can be interpreted in two different ways, depending on whether you see the glass as half empty or half full. According to a 2008 survey by the Centers for Disease Control and Prevention, 38.4 percent of doctors reported they were using full or partial EMR systems, and 20.4 percent said they were using minimally functional EMRs, including e-prescribing, the ability to order tests and view lab results, and electronic notes. In a 2006 CDC survey, the corresponding figures were 29.2 percent and 12.4 percent, respectively. Optimists might cite these figures as showing that physicians are really starting to embrace EMRs.

“But not so fast. When the CDC asked about EMR systems that conform to interoperability standards and are known as electronic health records (EHRs), just 17 percent of physicians reported having basic EHRs (which do all that basic EMRs do, and can also connect with other systems in a standardized way), up from 11.2 percent in 2006. Only 4 percent of respondents said they had fully functional EHRs, compared with 3.1 percent two years earlier.

“Here’s why the answers to the EHR questions are significant: According to the Department of Health and Human Services, to which CDC belongs, an EHR is considered interoperable if it is certified by the private, nonprofit Certification Commission for Healthcare Information Technology (CCHIT). Vendors of most full-featured EHRs have had their products certified by CCHIT for competitive reasons. So physicians who report they have a “basic” EMR are probably using a low-cost or older, non-certified EMR that can’t exchange data with other systems. Even practices with “basic” EHRs may not have the tools they need to use their systems for quality improvement or care coordination.

“So if someone tells you that nearly 40 percent of doctors have EMRs, remember that only 4 percent have fully functional EHRs that can do all the good things that health reform advocates want them to do.”

Hip-pocket appeal could drive PHRs

It’s a fact of life: no organisation, not even governments, likes to spend money on something unless they can see that it will make or save money. Well, here’s some evidence about the money-saving aspects of personal health records (PHRs) that should make governments, even in Australia, sit up and take notice. The AusHealthIT blog has uncovered a story about a US study that claims the implementation of PHRs across the American healthcare system will save more than US$21 billion a year, through things such as more efficient monitoring and sharing medication lists.

As AusHealthIT blogger David More writes, “If PHRs can deliver even half of these benefits I will take two, thanks!”

One important caveat – the study was funded by ‘unrestricted grants’ from companies including Microsoft and Google, which of course have a vested interest in the success of electronic PHRs…

NEHTA and the budget, part II

In a follow-up to my earlier post about NEHTA’s budget spend, they’ve gone from being criticised for underspending their budget to criticised for over-spending on the wrong things. Australian IT reports that the authority has more than doubled its spend on administration – staff, consultants, etc. – over last year, 169 people costing nearly $30 million. My calculator tells me that works out at nearly $178,000 per head, so either they have the best-paid staff in the public service, or the consultants, who account for $13 million of the total, are raking it in. Hey, how do I get on the gravy train?

Australians want e-health records

Australians support the introduction of an Individual Electronic Health Record (IEHR) and would agree to their medical records being included in the service.

This is according to a poll conducted on behalf of the National E-Health Transition Authority (NEHTA), which showed that 82% of respondents believe an IEHR would save lives and improve health services by having important medical information immediately assessable. 77% of the 2,700 people surveyed across Australia indicated they would want their records added to the service.

“This research confirms Australians endorse the use of electronic health records if they are introduced with all the necessary levels of privacy and security,” said NEHTA chief executive Peter Fleming.

The news was welcomed by AMA president Rosanna Capolingua, who reiterated the organisation’s long-time support of electronic health records, but also highlighted issues such as patient confidentiality and system access, as the issues delaying implementation. “Maybe not next year, but hopefully soon after we may see some movement,” she suggested.

Security and safety around the electronic storage of medical information was a key consideration, with 79% of those polled indicating it was important any future IEHR offers patients the ability to quarantine sensitive or very personal medical information. The poll also showed that Australians feel strongly about choice in relation to the IEHR. 78% of respondents said the IEHR service should be voluntary.

– From 6 minutes

From Medical Director to Microsoft – another Australian e-health delay drama

From today’s edition of 6 minutes:

“A pharmacy-driven electronic prescribing project announced with much fanfare earlier this year has hit a setback with one partner, prescribing software company Medical Director, going cold on the project.

“In March the Pharmacy Guild announced a ScriptX project to start in October which would allow GPs to create electronic prescriptions on a central encrypted hub that any participating pharmacy could access and dispense.

“But the project’s creators, pharmacy software company Fred Health, now says it is looking to work with new partners such as Microsoft to develop a similar system, known as eRx Script Exchange, to start next year.

A spokesman for the company, Mr Paul Naismith, told 6minutes that their original partners HCN, the vendors of Medical Director, had decided not to go ahead with the SciptX project as planned.”

Is this the precursor to Microsoft launching its HealthVault product in Australia? Meanwhile, no great surprises that HCN/Medical Director have backed out on the project; if a teacher was to give a report card on HCN, it would no doubt include the comment, “Does not play well with other children”…

Nobody said it was going to be easy – or cheap

David More’s AusHealthIT blog is always a good source of news and comment. Yesterday he wrote about the efforts of a hospital in the US state of Minnesota to introduce electronic medical records (EMRs). Over a four-year period the hospital spent US$250 million and involved 300 staff to implement the project across 11 hospitals and 70 clinics. To operate the electronic system in 2008 they are spending US$17.4 million, including 173 staff. All I can say is yikes!

As David writes, “The five main lessons he provided were:

Lesson 1: Implement enterprise governance—quickly

Lesson 2: Pay for physician leadership

Lesson 3: Avoid design by committee

Lesson 4: Set realistic expectations

Lesson 5: Prepare for ruffled feathers

These seem to me to be lessons all bureaucrats and implementers in Hospital projects in Australia should take very much to heart

The scale of the organisation make for quite sobering reading!”

If that’s what it takes to get it right, no wonder electronic solutions are slow off the mark in Australia.