Complex Issues Surround EHR Adop

April 16, 2009

Recently, I accompanied my mother to the hospital for cataract surgery and, the next day, to the eye surgeon’s for a follow-up visit. Both the hospital and the doctor’s office still use paper records exclusively. Multicolored folders filled floor-to-ceiling file cabinets that took up most of the doctor’s outer office while the hospital keeps its mostly handwritten patient records in 3-ring binders. The surgery took just 15 minutes and resulted in crystal-clear 20/20 vision in the affected eye. Impressive, especially considering that my mother is 81 years old.

Recently, I accompanied my mother to the hospital for cataract surgery and, the next day, to the eye surgeon’s for a follow-up visit. Both the hospital and the doctor’s office still use paper records exclusively. Multicolored folders filled floor-to-ceiling file cabinets that took up most of the doctor’s outer office while the hospital keeps its mostly handwritten patient records in 3-ring binders. The surgery took just 15 minutes and resulted in crystal-clear 20/20 vision in the affected eye. Impressive, especially considering that my mother is 81 years old.

Recently, I accompanied my mother to the hospital for cataract surgery and, the next day, to the eye surgeon’s for a follow-up visit. Both the hospital and the doctor’s office still use paper records exclusively. Multicolored folders filled floor-to-ceiling file cabinets that took up most of the doctor’s outer office while the hospital keeps its mostly handwritten patient records in 3-ring binders. The surgery took just 15 minutes and resulted in crystal-clear 20/20 vision in the affected eye. Impressive, especially considering that my mother is 81 years old.

Filling out the paperwork took more than twice as long. The hospital forms were similar to those already completed at the doctor’s office. (To make sure that the right eye was operated on, the nurse put masking tape above the designated eye.) It was easy to envision how electronic health records (EHRs) could streamline this process, free up storage space, ensure accuracy, screen for drug interactions and allergies, and seamlessly coordinate care between the hospital and the doctor’s office (though the application of low-tech masking tape will likely continue).

One goal of the massive “stimulus” funding legislation recently signed into law is to create EHRs “for each person in the United States by 2014,” for which the American Recovery and Reinvestment Act of 2009 allocates $19 billion over the next 5 years. Yet, even achieving this relatively simple and widely supported goal is far from straightforward, underscoring the perils in trying to fast-track comprehensive national health care reform. Two articles in the March 26 issue of the New England Journal of Medicine (NEJM) point out major obstacles to quick action on universal adoption of EHRs and especially to using them to improve the quality of care and contain health care costs. A commentary in the March 25 issue of the Journal of the American Medical Association (JAMA) examines the knotty issue of just who owns EHRs.

According to results of a survey of nearly 3000 hospitals published in NEJM, just 9% of hospitals have EHRs. The survey measured adoption of digital patient records only, not whether quality of care is assessed or tracked or whether delivery of care by multiple providers is coordinated. “We have a long way to go,” says Ashish Jha, MD, of Harvard School of Public Health, the study’s lead author. “We did not measure effective use. Even if a hospital does have EHRs, it does not mean it is sharing information with other hospitals and doctors.”

The second NEJM article is a perspective in which Kenneth Mandl, MD, and Isaac Kohane, MD, of Children’s Hospital Boston, argue against spending billions of dollars to support adoption of EHRs that use current technology of proprietary non-Web–based platforms. Instead, they say, the government should encourage development of an open software platform for which software developers could write EHR applications.

The question of who owns a patient’s EHR “needs to be addressed very soon if we are to both protect patients’ interests in their medical information and ensure that new information systems are put to their best uses,” says Mark Hall, JD, of Wake Forest University, and co-author of the JAMA commentary. The authors advocate for a new system of “patient-initiated control.”

The complexities of just this small piece of health care reform make the case for a cautious, incremental, and consensus approach to all aspects of health care reform to avoid costly unintended consequences. Too much is at stake for too many for comprehensive reform to be rushed through Congress in a simple majority vote. What do you think? ?