Electronic Health Records Today

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Electronic health records (EHR) are not new. The concept has been around since the first PC hit the stores. However, relatively few have cracked the code that gets doctors to enter the data necessary for the systems to work well, in a fluid and routine enough manner to see any return on their efforts. John Hallock of athenahealth points out, "The concept of electronic medical records as been around for 25 years, but it was basically all input for the doctors. Imagine Google Maps if you had to type in all the addresses yourself." Despite the much improved systems and greater reasons to use them, fewer than 20% of physicians' practices use electronic medical records.

Analysts of EHR find impressive savings and patient benefits. An October 2009 RAND Corp. study of 305 groups of primary care physicians in Massachusetts found that medical practices with EHR "Were more likely to deliver better care for diabetes and provided more types of health screenings than those who did not." A study reported by Hypatia Research, LLC found examples of significant cost savings. The report highlights a handful of specific examples including cardiology consultants in Pennsylvania who experienced an 88% reduction in transcription costs and saved $350,000 on filing-clerk staff and the MedCentral Health System of Ohio that eliminated radiology film costs of $450,000.

Over the past 2.5 decades, a number of things changed the landscape for healthcare information technology. There are three that stand out: The first shift was the invention of digital imaging. The use of magnetic resonance imaging (MRI) created a need to store image files digitally because an MRI is a 3D image that cannot entirely be interpreted on film and requires a computer to generate the image. With major vendors pushing the sale of computer systems to handle this data, hospitals began to build the data infrastructure to handle it. Next, a decade or so later, came the internet.

Internet technology was significant mainly because it provided the right type of decentralized architecture, or the right hook needed to draw out the leviathan of distributed and decentralized medical data. As trust in the security of data accessible via the internet has strengthened, it has relieved state, hospital, and provider system administrators of the dubious goal of trying to hold an ocean of information in a single spoon; specifically, bringing outside public health data inside a centralized client-server architecture of a state human services department or that of a single hospital, which was very expensive. As a result of this networked approach to health information, in the first decade of the 21st century, health information exchanges (HIE) sprang up throughout the country (with their big sisters the regional healthcare information organizations or RHIOs), and these began to make data available via the internet to hospitals in need of vital history on patients who needed treatment. While they are in no way complete or comprehensive, the HIE example demonstrated the benefits of EHR in a more public way than anything before.

Now again, something new is coming down the road: A big truck carrying $19 billion worth of incentive money is barreling down the healthcare superhighway. To pass briefly through the alphabet soup of new legislation, on Feb. 17, 2009, President Obama signed into law the Health Information Technology for Economic and Clinical Health Act (HITECH) as part of the American Recovery and Reinvestment Act. HITECH gave power and provided funds, to the tune of $2 billion, to the Office of the National Coordinator for Health Information Technology (ONC), an office that was formed under executive order by the second President Bush. The incentive consists of $19 billion to be disbursed over a 4-year period, in grants and loans, for infrastructure and incentive payments for providers who adopt and use health information technology.

Because of HITECH, hospitals, healthcare providers, vendors, HIEs, and RHIOs face both a carrot and a stick. Incentives are to be paid to eligible professionals and hospitals that are successful in becoming "meaningful users" of certified EHR technology. The meaningful use concept will be enforced by requiring physician practices, hospitals, and all other providers to report on statistics from their databases of patients.

There are no fewer than a thousand EHR systems deployed across physicans' offices, hospitals, and ambulatory care departments in the U.S. KLAS Research, a ratings company based in Orem, Utah, has been rating medical systems for more than 10 years. It covers 234 different EHR systems for ambulatory care out of the more than 1,090 it has listed. Top-rated systems in a recent report by KLAS that rates how vendors stack up in terms of the meaningful use requirement include Epic, NextGen, eClinicalWorks, GE, and Allscripts Enterprise, which all received top rankings by executives who purchased the systems.

Companies such as Quest Diagnostics see a huge opportunity in what Rohit Nayak, VP of sales, physician technology solutions for MedPlus, a subsidiary of Quest, terms "the woeful adoption of this technology." He adds, "We are in a perfect disruptive state because what was there is not reaching the patient needs." He applauds the HITECH initiative calling for meaningful use of the technology. "It is not about buying the system, it is about how it is being used and providing the user-centric output that has been missing from EHR systems."

Meaningful use is being tested by asking for reports, according to Nayak, such as a summary of LDL cholesterol levels or an incidence of diabetes. Unless a system is in place, these reports will be difficult to generate and submit.

Naveen Venkatachalam, a former IBM employee and founder of DoctorsPartner and Sushoo (so named for the sound of data whooshing through the internet), says simply, "This is like a gold rush, with the government handing out money like it's going out of style." His product will not benefit as directly from the gold rush as it targets smaller medical practices, so he is free to wonder aloud whether IT planners are opting for the most efficient and sustainable solutions. "Who is going to maintain the $5-million-a-year system after 2014?"

Venkatachalam, arguably, plays at the other end of the market, focusing on security concepts that allow him to leverage the internet to create a highly distributed architecture with data residing in cloud computing. Sushoo is an internet-based service that runs similarly to a health information exchange, linking up the various EHR systems that physicians have in use or licensing an "encryption server" in the case that they lack an EHR system. With his system, one doctor may "invite" another to view a document or test result electronically and in a manner perfectly compliant with HIPAA (Health Insurance Portability and Accountability Act).

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