Electronic Health Information – Small Steps, but No Giant Leaps




Health and Healthcare CategoryMore than 5 years ago in his state of the union address, President George W. Bush announced a goal that all Americans have electronic health records within 10 years. Since then, momentum has been building towards that target, but we still have a long way to go. A recent special article published online by the New England Journal of Medicine reported that less than 2% of American hospitals have a comprehensive electronic records system in place in all major clinical units.

According to the article, which was based on a survey of members of the American Hospital Association, electronic health records systems are more likely to be in place in larger, urban hospitals. Teaching hospitals and academic medical centers have also been leading the movement toward electronic health records. Currently, only 10% of American hospitals use a basic electronic records system in at least one unit. Twelve percent of hospitals have a clinical notes reporting system, and 17% have computerized order entry systems. A large number (approximately 75%) of American hospitals already have electronic laboratory and radiology reporting systems in place. These are small steps in the right direction, but still leave a long way to go.

HospitalThe appeal of electronic health records among the public, politicians, and the medical community is mounting, thanks to a growing, diverse American population, increasing socioeconomic health disparities, a medical system that emphasizes specialties over general practice, and a high incidence of medical errors. Ideally, electronic medical records will increase the efficiency and effectiveness of the provision of medical care, and reduce medical errors. An electronic health information system should provide information security, utilize common standards, exist in the public domain, provide support for all realms of health care, offer flexibility and responsiveness, and use standard Internet protocols and software. Electronic health information systems can include discharge summaries, electronic prescribing systems, anesthesia information systems, clinical note systems, clinical decision support, and many more tools.

So far, electronic health records systems have developed slowly in the United States. Strategies have primarily focused on improving immunization registries, regional health information networks, and insurance company projects. In part, the United States has been slow to implement universal electronic health information systems due to the lack of socialized medicine. Many European countries have an overwhelming majority of patients and health care providers participating in electronic health record keeping owing to the standardization and socialization of health care. American hospitals and health care providers currently choose their own vendors for software and training of electronic health information systems, leading to far-from-standardized record keeping and an inability to share information among providers.

In February 2009, President Barack Obama signed into law the American Recovery and Reinvestment Plan, allocating $20 billion to implement electronic health care records and provide training for health care staff that use the systems. While achieving the electronic health records standard by the 2014 goal set forth by the former president is highly unlikely, this financial stimulus may provide the impetus that the medical community needs to adopt electronic medical records. Adopting these systems improve the quality of care, patient safety and satisfaction, and overall efficiency. However, the costs associated with implementing electronic health information systems are prohibitive for many providers and hospital systems; further, the costs saved in the long run are not realized by the providers, but by insurance companies, patients, and society in general. Additionally, the successful implementation of the system requires lost productivity and a negative impact on workflow — hard choices to make in a time-crunched medical environment.

The lack of electronic health information systems in the United States represents a fundamental flaw in the provision of medical care today. This country is behind the times in this venue, and needs to commit the time and financial resources to bring the health care system into the 21st century.

References

CUSACK, C. (2008). Electronic Health Records and Electronic Prescribing: Promise and Pitfalls Obstetrics and Gynecology Clinics of North America, 35 (1), 63-79 DOI: 10.1016/j.ogc.2007.12.010

FRIEDMAN, L., HALPERN, N., & FACKLER, J. (2007). Implementing an Electronic Medical Record Critical Care Clinics, 23 (3), 347-381 DOI: 10.1016/j.ccc.2007.05.001

Hollar, D. (2009). Progress along developmental tracks for electronic health records implementation in the United States Health Research Policy and Systems, 7 (1) DOI: 10.1186/1478-4505-7-3

Jacobs, B. (2007). Electronic medical record, error detection, and error reduction: A pediatric critical care perspective Pediatric Critical Care Medicine, 8 (Suppl) DOI: 10.1097/01.PCC.0000257484.86356.39

Jha, A., DesRoches, C., Campbell, E., Donelan, K., Rao, S., Ferris, T., Shields, A., Rosenbaum, S., & Blumenthal, D. (2009). Use of Electronic Health Records in U.S. Hospitals New England Journal of Medicine DOI: 10.1056/NEJMsa0900592

LAGREWJR, D., STUTMAN, H., & SICAEROS, L. (2008). Voluntary physician adoption of an inpatient electronic medical record by obstetrician-gynecologists American Journal of Obstetrics and Gynecology, 198 (6), 6900-690000000 DOI: 10.1016/j.ajog.2008.03.022

  • The implementation of electronic medical records faces huge obstacles. In particular, the use of stimulus funds has been criticized in conservative circles: Health ‘Reformers’ Ignore Facts, echoed by Greg Mankiw.

    Preventative care, disease management and electronic medical records are also constantly cited as big cost-savers. The idea here is that if our health-care system was set up to prevent disease rather than just treat it, and could do so without duplicative paper records, it could save money. It’s a great hypothesis, but research does not indicate it amounts to much. “In many cases,” as Mr. Elmendorf testified regarding such initiatives, “those studies do not support claims of reductions in health spending or budgetary reductions.”

    This is a dumb argument, and you’d think Mankiw and Pipes would know that. The idea is not to reduce the total outlay of money. The idea is to make the health care system more efficient. That way, more of the money is devoted to helping patients, as opposed to moving stacks of paper around.

    Having said that, I personally doubt that the use of stimulus funds, as proposed, is the best approach. I would favor funding an open-source group, such as the Mozilla Foundation, or even Wikipedia, to take the US government’s VA Hospital EMR system and adapt it to civilian hospital use. The VA system is already open-source, as a work of the government. It is well-tested. Many doctors and nurses do at least some of their training in VA facilities, so there is a widespread, established user base. The system has been demonstrated to be able to interconnect successfully, and can handle a very large amount of data.

    The resulting software would be free. The development would require some funding, as would the ongoing maintenance.

    This strategy would be perceived as anti-business, but it would get the job done.

  • Rob

    Electronic health records are key to the future of the American health care system, but there are steps that those of us who are neither hospital IT directors nor high-level policymakers can take to both improve our own health care and guide the coming change in the right direction:

    * Sign up for an online patient health record account – I use HealthVault.
    * Talk to our doctors (and other providers) to make sure that they see the value of electronic health records.
    * Talk with friends and family to get them to take the same steps.

    We can make the most of our amazing information technology to get healthier without giving up our privacy or spending any more than we already are.

  • David

    While hospitals can definitely benefit from emr , smaller practices can benefit from electronic medical records as well, especially when integrated with practice management software.

  • Emma Jackson

    I am not a professional but I really amazed with all the advantages of electronic health records as you can correctly prescribe all the medications.

  • Implementing new technology is the key to success in medical business. Maintaining the medical records of the patient as Electronic Medical Records (EMRs) is one of the recent technologies that would help the growth of the medical business and could improve the quality and accuracy of medical-record documentation.It will definitely lead to better care.

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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