Society | DOI: 10.1145/1592761.1592770
Leah Hoffmann
implementing electronic
medical Records
Despite a number of challenges, patients’ medical records
are slowly making the transition to the digital age.
IN 2004, PresideNT George W. Bush set an ambitious goal for the American health-care in- dustry: by 2014, he wanted all citizens to have access to an
electronic medical record (EMR). Earlier this year, President Obama reinforced the federal government’s commitment to that target, and announced
that nearly $20 billion in stimulus money would be available during the next
five years to help health-care providers
implement digital record systems.
EMRs are widespread in Europe,
Australia, and elsewhere, but only 4%
of American doctors have a fully functional system, according to the New
England Journal of Medicine. Another
13% use a basic one. For patients, the
benefits are obvious—convenience,
portability, and efficiency. EMRs also
offer benefits to health-care providers,
including the reduction of clerical errors and computerized decision support. And scientists are excited by the
technology’s potential for furthering
medical research.
For years, however, the economic
incentives simply weren’t powerful
enough. Although studies suggest
EMRs could save billions of dollars
each year, the complexity and cost
of developing, implementing, and
managing the technology meant that
American health-care providers—most
of whom work in small practices with
fewer than five physicians—found little reason to adopt it. “When a physician invests in EMR, 89% of the benefit
goes to someone else,” says Blackford
Middleton, director of Clinical Informatics Research & Development at
Partners HealthCare in Boston. Insurance companies, Middleton notes, are
often the primary financial beneficiaries, saving money by streamlining the
claims process and reducing duplicate
tests and procedures. It’s an imbalance
the spanish Peaks Regional health center, based in Walsenburg, co, plans to make the
transition to an electronic health records system before the end of 2010, which will eliminate
the need for office assistants to wade through piles of paper-based patient records.
that the federal stimulus, which makes
physicians eligible for up to $64,000 in
incentives (and hospitals for up to $11
million) beginning in 2011, may help
overcome. But EMRs also present a
number of other challenges involving
protocols and standards, privacy, and
how physicians practice medicine.
Protocols and standards
One of the main difficulties is the
lack of protocols and standards. Several groups across the country have
developed their own EMR systems,
including Partners HealthCare, the
Cleveland Clinic, and the Regenstrief
Institute in Indianapolis. Hundreds of
EMR vendors offer products, too. But
standards for the collection, exchange,
and retrieval of electronic medical information vary widely from system to
system. The Healthcare Information
Technology Standards Panel (HITSP),
a private-public partnership, has
worked since 2005 to harmonize protocols and standards, and the Obama
administration has already convened
two federal advisory committees to
help tackle the problem. The trick,
according to industry watchers, will
be finding the right balance between
standardization (which helps ensure
interoperability and information
sharing) and flexibility (which accommodates the various systems and architectures that different health-care
providers need). Britain’s National
Health Service (NHS), for example, has
fielded fierce criticism from clinicians
about its plans to digitize the country’s health system, which are derided
as rigid and inadequate.