The United Sates is a laggard in the adoption of electronic health records, trailing Europeans by a country mile. A recent study by Harvard’s School of Public Health found that of 3,000 acute-care hospitals surveyed in 2009, only 1.5% had comprehensive electronic health record systems, and only 11% had some parts of their health records computerized. Contrast that with 90% or above adoption rates in European countries, and you will begin to understand at least one of the reasons why our healthcare costs are significantly higher than that of Europeans, while delivering lower overall public health, as measured by infant mortality and life expectancy.
The runaway cost of healthcare, at $2.5 Trillion in 2009, is expected to rise to $4.3 Trillion by 2017 or 20% of GDP, according to a recent study by McKinsey. Despite spending astronomical amounts, 46 million American are uninsured. The Obama administration has targeted e-health records as an initiative to contain costs and increase the quality of service, by allocating $19 Billion for this effort in its $787 Billion stimulus plan.
There is a significant opportunity for entrepreneurs and established companies to thrive in this sector. However, before the software and hardware companies stampede toward this new gold rush, it is time to pause and ponder some key criteria for transforming the nations healthcare records. For e-health records to be effective in reducing costs and improving the quality of healthcare, they must meet the following criteria:
- Be user friendly. Most e-health record systems are designed by software engineers, with minimal inputs from its primary users: doctors and nurses. The result is that most doctors and nurses see these systems as intrusive bureaucratic procedures that get in the way of delivering quality healthcare. If a physician has to take any more time entering data than filling out the paper chart, this initiative will not be adopted. To quote a Silicon Valley adage, the dog must like the dog food.
- Interoperable and compatible. Every e-health record vendor is building systems that differentiate its product from other offerings. Unfortunately, this also makes –health record systems incompatible with each other. Data compatibility is critical to rapid adoption of this technology. I recently changed dentists due to a change in HMOs. My new dentists electronic system could not read the X-Rays and other records from the previous dentists. I had to undergo another x-ray at the new dentist, adding to the HMO’s cost.
We cannot create islands of incompatibility, and expect the system to deliver efficiency and cost savings. It took a set of standard communication protocols called TCP/IP to create the Internet. Data communication existed before the Internet. But it was the use of standard technologies that made the Internet a driving force of economy. FYI, make sure your software is HL7 compliant and you incorporated the FHIR server for data management and storage.
The cell phone industry in the United States emerged with an alphabet soup of incompatible standards: TDMA, CDMA, GSM, 3G versions of the same and so on. As a result, each carrier has its own set of transmission equipment to support a particular technology. The Europeans, by contrast, adopted a single standard – GMS, and its 3G version – and were able to build a more cost-effective, interoperable network.
Sometimes, the free market will let standards emerge, like the Internet protocols and Portable Document Format (PDF). At other times, it has to be nudged along by the largest user of this information, which arguably is the government through Medicare and Medicaid. He who pays the piper calls the tune. Just like the PCs vs. Mac debate was made irrelevant by Apple adopting standard technologies such as Intel processors and Unix-based operating system, the e-health record system vendors have to adopt a set of common standard formats and communication standards so as not to end up with the Tower of Babel of health information.
- Affordable. According to a recent study by American Academy of Family Physicians, E-health record systems can cost from $30,000 to $50,000 per physician. This is a significant investment. The government can help by writing down this cost. $17 Billion of the current stimulus plan is allocated for it in form of Medicare and Medicaid reimbursements. However, no up front relief is offered. Physicians need greater incentives to adopt this technology.
- Secure and hacker proof. This may be the biggest barrier to adoption of e-health records. Hackers today routinely break into the networks of businesses, banks, and government departments. We hear regularly about millions of social security numbers compromised either due to theft, or careless use on the part of an employee. Our health records are out most personal and precious data. Unless the vendors and government can gain users’ trust by strictly enforcing a set of security protocols, the adoption goals will remain elusive. Every new technology creates its own set of vulnerabilities. The e-health systems need layers of security to ensure user confidence.
- No hidden agenda. There is a widespread fear in the society of “socializing” the practice and delivery of medical care. A significant portion of the population believes that the government will use the data mining techniques to make decision such as what treatments to approve for individuals. This concern is real, and will get in the way of e-health record systems adoption unless the government builds specific safeguards in the system through legislation.
Implementing e-health records is not easy. The UK Government’s $18 Billion e-health record initiative is four years late, having run into repeated problems, with some prime contractors walking away due to the complexity and constant changes required by the various constituents. E-health records, if done right, will deliver the $80 Billion in savings that the government promises. However, they are no panacea for all our healthcare ills. If we do not pause and learn from the experience of other countries in adopting e-health records, we may be building a new Tower of babel.