products are designed to use “cloud
computing,” meaning medical offices
would need only lightweight clients
communicating with remote servers,
a potentially lucrative data-center market for companies like Perot Systems
and telecom giants like Verizon.
THE SCIEN TIFIC COMPU TING AND IMAGING INS TI TU TE AT THE
unIVersIty oF utah; httP://www.sCI.utah.eDu/
protect against malpractice liability,
high drug prices, advanced technology,
and increasing numbers of uninsured
people unable to access affordable
preventive care. Though these factors
are all politically loaded, some 28 percent of healthcare costs are due to the
combined contributions of program
administration ( 7 percent) and physician services ( 21 percent), according to
the Kaiser Family Foundation based in
Menlo Park, CA.
But even if EMRs were able to
reduce operating costs in the long
run, the initial investment is significant. Doctors not yet using EMR and
related digital services face a potential investment averaging $20,000 to
$40,000 each to acquire the software,
hardware, IT support, and training
to implement a system. As a result,
EMR adoption is highest among large
medical groups better able to afford it,
like Kaiser Permanente and the Mayo
Clinic. Much more resistance is found
across the thousands of small and individual practices in the U.S.
Because both sides of the political
aisle seem to agree that EMRs can
reduce at least some of the expense of
U.S. healthcare, the provision in the
Obama administration’s recent healthcare reform proposals to allocate $19
billion to subsidize EMR adoption is
among the most likely to be included in
any final legislation.
The federal subsidies would reimburse doctors up to $44,000 each
for adopting and using government-approved EMR systems. But even this
would require that doctors contribute
the costs of up-front acquisition. In any
case, government money won’t begin
to flow until after healthcare reform is
enacted, if it ever is.
Anticipating a boom in EMR adoption across the U.S., vendors ranging from Dell to G.E. to IBM—plus
many specialized players in hardware
and software, like eClinical Works
(used by Wal-Mart)—are positioning themselves to sell and service
these systems. In the past, one factor
driving the costs of EMR adoption
was installation and maintenance
of server hardware. But the newest
Protocols, Standards,
Interoperability
Looking beyond the considerable
challenges of protecting patient privacy and paying for mass migration
to EMRs, electronic recordkeeping
and guidance systems will be limited
if they’re unable to communicate with
one another.
EMRs require at least two levels of
standardization: one for data exchange
to ensure applications read data provided by other applications; and one
for terminology called “controlled
medical vocabulary,” or CMV, to
ensure that different providers use the
same terms to describe the same medical conditions.
One such CMV—SNOMED CT
(Systematized Nomenclature of
Medicine-Clinical Terms)—is a coding system that describes more than a
million terms for diseases, diagnoses,
procedures, and medications. The
system consists of hierarchical medical
concepts assigned to ID numbers; for
example, ID 208892001 translates as
“closed traumatic dislocation of hip
(disorder).” These “canned” concepts
are coordinated with other systems,
such as Health Level Seven, an international organization that defines
standard terminologies for many sub-specialties in medicine. The SNOMED
CT syntax allows practitioners to
use standardized forms to describe
