Healthcare challenge: Overcoming the downside of EHR

Senate Finance committee hearing on overhauling the heath care system.  From left: Robert Greenstein, Center
on Budget and Policy Priorities; Leonard Burman, Urban Institute; Katherine Baicker,  Harvard School of Public Health,
Joseph R. Antos. American Enterprise Institute;  and Stuart H. Altman, professor of National Heath Policy.
(AP Photo/Pablo Martinez Monsivais)

 

The potential value and cost savings of Electronic Health Records (EHR) seem so self evident it is counter-intuitive that any barrier could derail the program. American medicine has been a leader in adopting new digital technologies, but a number of roadblocks have slowed embrace of EHRs. 

A study by Dr. Steven Simon at the Harvard Medical School found only 18 percent of Massachusetts practice offices had EHRs. Simon found that even among practices using EHRs, most physicians did not take full advantage of system functionality.

This is not terribly surprising. Britain, the most dedicated single payer system, has had difficulty deploying EHRs ordered in 2002. The British press says the system is four years behind its implementation goal. Although physicians in comparable countries have much higher computer use than U.S. doctors, it has not been an easy transition there either.

Reading between the lines, there may be a clash of hidebound cultures torpedoing EHR progress. Certain EHR functions are more popular than others. E-prescriptions enjoy favored use. Systems alerting doctors to drug interactions and substitute generics are popular.

Despite a thriving Health Information Technology (HIT) sector, only 1.6 percent of U.S. hospitals have made full migrations to EHR.

Part of the challenge is an inability to agree on desired functions. A $34 million Consolidated Physician’s Order Entry system for a west coast hospital system was abandoned when administrators finally threw up their hands.

Other concerns are EHR security, privacy, sufficient qualified information technology personnel to manage the system, cost of implementation, and interfaces that allow various existing proprietary solutions to communicate with each other in a useful way.

Security, privacy and insufficient personnel:

That physicians will be able to access information online and between facilities raises the specter of hackers holding information for ransom. Investigation of an invasion of prescription records in Virginia is ongoing. Officials doubt it took place and are on the trail of blackmailers.

Proponents of EHR say layered levels of security actually make records more secure. There is nothing in place now to stop a night shift janitor from reading any paper file, , and selling the information. Digital records have audit trails that show who read what, from where, and for how long.

Privacy and misuse will need to be controlled through harsh enforcement. Lack of sufficient trained individuals has moved data storage and management from onsite locations to redundant remote data farms operated by vendors.

The British experience teaches us single, top-down EHR solutions are probably not viable. Interfaces between existing systems make more sense and protect investments already made. Similar interfaces already exist in other industries. Communication between airline ticketing systems interacts seamlessly.

Cost concerns can be overcome by some advance government funding and payment penalties which encourage participation in migration to EHR.

As with most changes, the golden rule applies. “He who has the gold makes the rules.” The optimistic administration target for EHR migration is 2014. $19 billion already allocated to this purpose is a “golden start.” Funding availability begins to individual practices in 2011. Practices and institutions not making significant progress towards digitization will suffer a 1 percent per year penalty reduction in their Medicare and Medicaid payments accelerating by another 1 percent each year afterwards for non-compliance.

Learning from the British experience, the administration has wisely set up a yet-to-be-named referee in an Office of a National Coordinator (ONC) under HHS. The ONC will certify systems, make grants, and mediate disputes between competing interests. Certification will facilitate information interchange without requiring one national standard.

The ONC will also establish two independent commissions. One will encourage health industry inputs on operations. The other will mine medical data and help suggest best practices based on patient outcomes.

They hope this collaborative will improve care and reduce costs overall.

Next: The Cost of Administration
 

As America searches for solutions leading to a reformation of its own health care system, knowing the successes and shortcomings of health care regimes in other developed nations will be essential in negotiating the most palatable and efficient design for all concerned. This series attempts to connect the dots and explode the talking points in hopes that the folks who actually have a vote might come to a conclusion.

Al Portner is a former daily newspaper editor and publisher in seven states and author of the forthcoming “Mark Twain and the Tale of Grant’s Memoir.” Portner is also the proprietor of The Assignment Desk, LLC and provides writers, editors, and photographers for numerous kinds of contract projects from proposals and speeches to public relations and journalism. Reach him at alanportner@gmail.com.

 For more info: 
Simon Report Abstract
A one size fits all solution is wrong for America
Primary care practices needs are key to "Meaningful Use" of health IT