US Government plans to promote Electronic Health Records

Will they get it right this time?

Embedded in the so called “economic stimulus plan” the US government wants to dedicate the considerable amount of $20 billion to health information technology to ensure a comprehensive distribution of Electronic Medical Records (EMRs). This shows clearly that SCG’s opinion that health information technology constitutes the key role for a reconstruction of today’s collapsing healthcare systems is shared by the US government. This is not new and the history of attempts to ameliorate the structural deficits in this field is long. It is interesting to have a look at current statements of the medical community about those efforts that is influenced very much by the caregivers’ personal up-to-date experience with medical information technology. This look will help us to identify the essential issues of a new health information culture that are crucial to achieve the so much overdue paradigm shift.

In doctors’ discussion boards, you find decidedly mixed statements like the following:

 “EMR is the worst thing that ever entered my practice rooms. It takes away time from the care of patients and quality is not increased. It is not able to transfer and storage the information that is really relevant in a patient contact without a massive extra-workload.”

“I purchased an EMR system but had to spend an immense amount of time to streamline it to the needs of my practice. Now it is a valuable tool.”

“I love electronic health records. They include hospitalization reports, lab reports, x-rays, as well as office notes and have increased my quality of care immensely. They made it possible to spend more time on the direct doctor-patient contact.”

How are the general trends?

Statements from general physicians are mostly on the negative side. They complain about insufficient adaptability of IT-systems to their work situation, overcomplicated interfaces and growing administrative overhead. Frequently they have the impression of a bad cost / value relation. They describe painfully high costs of implementation and maintenance.

Most specialists respond more positive, they stress the importance of a rapid overview of the patients’ medical history that electronic health record systems provide. Still there is a lot of negative feed-back on the tendency of such systems to restrict the workflow rather than to streamline it by lack of flexibility. Frequently a huge personal effort is necessary to make today’s solutions workable in specific work-situations.

The most negative response comes from doctors who are working in large healthcare centers especially in primary healthcare centers. They observe that the implementation of EMRs leads to a further blowup of administration and additional work for the physicians without appropriate medical benefit.

All professional groups complain about the missing standardization of different EMR systems making the choice of an appropriate future-proof system a tedious and risky task.

 Many physicians who feel generally positive about the incorporation of EMRs into their workplace therefore wait until a better standardization is achieved and are afraid of high implementation and support costs they would have to invest in an island solution that will become obsolete before long.

And although doctors’ forums tend to deal mainly with doctors’ problems it was very surprising for me that I found nearly no description (positive or negative) of patient response to EMR systems. Do physicians and the health administration really think that a far reaching change like the information technology revolution in medicine will develop without patients’ perception and reaction?

The above mentioned problems are old and well known; an effective solution for the disastrous information culture in medicine is overdue and will revolutionize the art of medicine and save incredible amounts of healthcare money associated with a massive gain in quality of care.

The beneficial intention of the US government to strengthen healthcare information technology will only work if the shortcomings of today’s solutions are avoided.

The overdue quantum leap inevitably relies on a seamless incorporation of modern IT- technology into the clinical workflow of all caregivers. The medical benefit has to be in the center and not pure administration purposes. The patient has to be an emancipated partner in the information flow and a standardized information exchange platform for all participants in the healthcare process is mandatory. Without these basic ingredients of the health IT revolution the necessary paradigm shift in medicine will not occur and we will see again good intentions but insufficient results, only this time with even more money spent.

Let us hope for the best.