EHR – Part v. Whole

February 10, 2010 at 10:06 am 2 comments

Piecemeal vs. Wholesale

The Center for Disease Control (CDC) recently released the results from the 2008 National Ambulatory Medical Care Survey (NAMCS), which is “an annual nationally representative survey of patient visits to office-based physicians that collects information on use of EMR/EHR.”  Approximately 5,200 physicians (3,200 surveys conducted in person; 2,000 over the phone) responded to this survey, which is conducted by the National Center for Health Statistics since 2001.   The survey is designed to figure out how many physicians have purchased some product to serve as the Electronic Health Records (EHRs) – also referred to as Electronic Medical Records (EMRs) – and how many are utilizing those products.

There has been a big push for adoption of electronic health records, especially since the government set a goal of having most Americans have an EHR by 2014 (set in 2004 by then President George W. Bush, and has been re-affirmed by President Obama).  Increased funding from the Department of Health & Human Services for electronic medical records and products that electronically capture health information has also led to a boom in the Health IT industry and a diversity of options for health professionals from which they can choose.

But such an abundance of choices combined with the rush to adopt EHRs has left many people wondering – what’s the best product out there? Perhaps the better question is – what’s the best approach for implementing this new system?

Survey results, rising doubts and some ideas after the jump…

The 2008 survey asks participating physicians if their practices “use electronic health records (not including billing records).” 41.5 % responded that they were using all or partial EHR systems (the options being “Yes, all electronic; Yes, part paper & part electronic; No; Don’t Know).  The previous year’s results were 34.8% claiming to have all/partial EHR systems.

Additionaly, the survey goes on to ask them to rate their EHR system as either “basic” or “fully functional” which NAMC defines.  Basic systems capture patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory & imaging results.  Fully functional EHR systems capture everything a “basic system” does as well as medical history and follow-up, orders for tests, prescription & test orders sent electronically, warnings of drug interactions/contraindications, highlighting of out-of-range test levels and reminders for guideline-based interventions.  2008 survey shows that 16.7% of responding physicians reported having “basic systems” with 4.4% reporting they have “fully functional systems.”  These numbers are slightly increased from 11.8% for basic and 3.8% for fully functional systems reported in 2007.

Growing numbers of physicians are adopting EHRs, but are these systems serving the physicians’ needs?  In this Huffington Post Investigative Fund article, reporters found many anecdotal examples of companies being unable to support physicians’ offices, going bankrupt, and overall being unable to meet the standards and needs of their health professional users/customers.  While there’s no indication that this is a widespread problem, and not much hard data is given outside of the examples provided, it is still a risk facing all adopters interested in acquiring an EHR.

So what’s the better way of minimizing that risk while reaping the benefits an EHR can provide?  One idea is not to approach EHRs as an overarching operating system (OS), but instead as a system made up of multiple parts.  Children’s Hospital Informatics Program (CHIP) released “a set of core principles to guide the creation of a new health information infrastructure to better support the nation’s complex and evolving health system.”  These principles are intended to be used to figure out how to create interchangeable, adoptable applications that can be acquired by physicians to serve their specific needs.

As people, including mTuitive’s own Peter O’Toole, have framed it – this would be akin to acquiring programs and applications via the iPhone/iPod touch App Store.  It would be up to the developers of these products to make sure they can be easily integrated with other programs and can easily communicate between systems without sacrificing security or integrity of the data.  Different aspects of medicine require different information gathered and different information dispersed.  It is unlikely that one system has a cure-all that can respond to the needs of a pathologist, surgeon, nurse and lab technician without asking for a lot of compromise in the process of capturing that data or in the data itself.  However, if developers can specialize in one aspect of health care while ensuring that it can easily adapt to any environment (either integrating it system-wide or just in one department) – then the users will ultimately benefit even greater from this.  And this doesn’t just apply to hospitals – doctors’ offices also could make up their own “Frankenstein EHR” that patches together the best practices and most efficient programs to better serve their unique and specific needs.

As opposed to approaching EHRs as a giant sea change, a monolithic one-and-done adversary that needs to be grappled with and controlled – CHIP’s principles coupled with specialized applications mean that physicians can be more selective and only tackle the aspects of EHRs that actually affect their work and their patients.  And since the entirety of the patients’ care isn’t being entrusted to just one company or a sole product, the risk is lessened if that company or product just one link in a chain of solutions.


Entry filed under: EMR, Standardization, Studies. Tags: , , , , , , , , , , , , , .

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2 Comments Add your own

  • 1. christophereldredge  |  February 10, 2010 at 12:03 pm

    There can be only one

  • […] There is a good reason to be concerned if physicians and hospitals are simply rushing to purchase EMRs to take advantage of the federal funding available for physicians.  As I’ve stated before, electronic health solutions are being adopted at a much faster rate than before due to a confluence of federal funding, improvements in the technology and the growth of the Health IT Sector all coming together at one moment in time.  And these changes have left many in the medical community scrambling to hastily adopt a system – a system which might have many errors or may not be the right fit for that facilities/user’s needs. […]


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