So with all this talk about healthcare technologies and the new budget and Health 2.0, you’d think that electronic medical records (EMRs) were on the rise. Perhaps they are, but as the Associated Press reports, fewer than 2 percent of providers have completely abandoned paper charts. Another 8 to 11 percent of hospitals have basic electronic systems in place where at least one department has converted to digital. Not exactly the tidal wave that some blogs suggest is happening…
The most common obstacle to conversion cited by the surveyed hospitals was cost — $20 million for small hospitals to $200 million for large academic centers. About three-quarters of hospitals without a computerized system said lack of capital was a barrier, 44 percent cited maintenance costs and 36 percent cited doctor resistance, according to the survey of 2,952 mostly small and medium U.S. hospitals conducted last year.
For smaller physician offices (like a single physician or small group practice), costs start at $50,000 and can easily balloon to $200,000 without breaking a sweat. This isn’t easy stuff, and unless someone starts writing large checks to these folks, you won’t see any quick adoption of electronic medical records soon. It’s an expensive and time-consuming quagmire, not a cure-all, and “solutions” like Microsoft’s HealthVault are really just a part of a complex equation that virtually everyone under-estimates.
So while some folks continue to extol the virtues of these technologies as though they are inevitable and a cure-all, they remain a tiny, tiny percentage of what most hospitals and providers offer. And for good reason, because as the article notes:
But a third of hospitals surveyed said they were unsure whether they would recoup their investment. And the Congressional Budget Office last year said the adoption of more health technology alone is “generally not sufficient to produce significant cost savings.”
We know such record keeping can help reduce documentation errors (and as a result, medical errors), but as of now, the jury is still very much out as to how quickly such record keeping systems can be implemented to help e-patients.
Read the full article: Study: Few US hospitals use digital records
So John! What’s the fix? Is there one, or are we just SOL?
Another aspect of my past has been creeping into my consciousness: workflow. When I worked in the newspaper industry years ago (remember newspapers?), designing & marketing & installing production systems, we learned the hard way that many old dogs don’t even like to learn new tricks, i.e. change the way they work. More system failures were due to that than to the systems themselves.
So I’m starting to get really concerned about the viability of installing systems in existing hospitals. They have far more specialties and jobs than newspapers do.
It’s sorta like adding Internet cabling to existing hotels: it was easier to just build new ones.
Are we gonna end up just growing a new generation of hospitals, pre “wired” (socially) to work with the new system, rather than trying to retrofit new workflow into existing stodge?
I was very glad to see today’s New York Times (http://www.nytimes.com/2009/03/26/business/26health.html?_r=1&ref=business) make a point that’s been sorely lacking in this discussion. Much of the ambivalence/opposition to EMRs that I’ve seen seems to pre-suppose that the health care profession is stuck with the “1.0” systems currently available. Doctors complain (legitimately) about awkward user interfaces and inflexible systems that make them select from menus of inadequate choices. But the shortcomings of the current interface should NOT be confused with the value of the technology overall. Anyone remember the early word processors? They were ugly to use, but we put up with them because they represented a real advance over the typewriter. Soon enough, innovation moved in, the technology improved and word processing went mainstream. Today we have a thriving open source technology movement. Let the open sourcers have at EMRs!
Jane Sarasohn-Kahn has another good take on this article:
EHRs – not about the machine, but the data liquidity
As someone who just spent two years on a website re-do, including a new content management system, I am in touch with the frustration that people feel regarding imperfect software and systems. If you talked to me on a bad day, you might never want to get involved in the details of a website redesign and launch. It’s hard. It takes more time than most people estimate. It costs more than you think. Hardly anybody speaks well of the process. And that’s the message that a lot of people hear about EMR systems. But the reality (for me anyway) is that there is no choice but to move forward.
Check out related articles at http://www.wikinomics.com/blog/index.php/author/jperron/
An interesting interview with the docs proposing the open sourcing of EHR software: http://www.technologyreview.com/biomedicine/22360/?nlid=1896
Even though the investment in electronic medical records systems is at first costly, most argue that over time this outset cost will result in greater savings for both clinicians and health insurance companies.It’s a well written article.