Friday, July 27, 2007

Making Progress Towards EHRs?

The May 28, 2007 issue of InformationWeek included a comprehensive article titled Why Progress Toward Electronic Health Records Is Worse Than You Think. It cuts through much of the hype about the US experience with EHRs and cites a number of examples.

While there is evidence of an increase in the use of electronic health information systems, the long sought-after change in health care provider behaviour, data-sharing, is lagging far behind. The most encouraging example cited was the Indiana RHIO created by the Regenstrief Institute, which was developed over 30 Years! "The secret of success is having patience," says Dr. Marc Overhage, Regenstrief's director of medical informatics.

My own experience is that any successful system in health care takes at least 10 years from first concept to full implementation and integration into business processes (not including implementation of straightforward and mature HIS's - note the near-obsession with PACS as an early win in the EHR game). 30 years is not unrealistic for the integration of many disparate systems and the associated changes in health care provider behaviour through what amounts to a complete re-engineering of the care delivery process. Most proponents of EHRs will argue that that's not good enough.

Perhaps not, but it is reality.


Michael Martineau said...

While I can understand your point of view, I would also argue that 30 years is way too long! The commercial Internet is arguably less than 15 years old (1993 - release of first web browser, Mosaic). Look at the level of adoption and the way that it has fundamentally transformed many businesses.

Why has the Internet been so widely embraced? Because it offers useful functionality that was not previously available. I contend that the EHR must be coupled with clinical applications that use information in the EHR to drive wide adoption. When a clinician can do something that they could not do without the EHR, something that is meaningful to them, we will see widespread and rapid adoption. Also, don't under estimate the impact of the emerging healthcare consumer who is already conditioned to do many other activities on-line.

Michael Martineau
eHealth Practice Lead
Branham Group Inc.

Brendan Seaton said...

Re: Michael's comment - I should also have noted that I first heard the term EHR in the early 80's, almost 25 years ago. Perhaps that means we only have 5 years to go... Though this issue is never technology, or even the technical sophistication of users. Its all about the complexity of the health system with its numerous players, power structures and business relationships. The technology is easy. Its people and their behaviour that is hard.

Michael Martineau said...

In fairness, the Internet was first "invented" in the mid 1960's. It wasn't until the early 1990's that it started to gain notice outside the academic community and not until the mid 1990's with the advent of the web that it started to get commercial attention.

I think that the conditions for EHR adoption are much different today than in the mid 1980's. Clinicians are increasingly likely to have a computer at home, bank on line, use email to communicate with family members, etc. Hence, they are more comfortable with IT and what it can do with them. Also, the technology has matured to the point that it much more usable. Finally, I think that are enough success stories about the benefits of integrating IT into clinical practice that we have a much more willing audience than even five years ago.

Based on my observations of the market I believe that we will see much more rapid adoption in the next 5 years than we have seen in the previous 25 years.

Michael Martineau
eHealth Practice Lead
Branham Group Inc.

Dr.Hamza Mousa said...

Quote Brendan : "Its all about the complexity of the health system with its numerous players"

Yes the System became really complex but i see the real player is still missing or slow ....

it's not about when , it's about who and why ?!..

Health Informatics Medical Informatics Industry not Just The Technology , advanced or basics it always needs a compatibility between the players and the system..

as new doctor raised in family of doctors i seen the Doctor 1.0 Generations is still confused some how with the Technology progress
but at the collage i realized the new doctor " Doctors 2.0 " used the Technology more than add ones .... so the player will go advanced so the system will be mature ...

the system was slow , yes , especially with kind of communication between 2 different minds ...
as example

years ago , the Head of Our Medical Collage wanna an EHR for the hospital a New One .. so in the meeting with the developers ( i was there ) i notice the developer unaware of the medical issues and the doctor also unaware of the Technical needs and forsite look for the future of the project...
this problem in communication could be solved with alittle understanding of the other's work.

so as a Doctor and also a Developer/coder i notice a lot of stuff needed to be fixed as many systems i used , and the perfect system i worked on are what the doctors made ... even if it was not that advanced or mature .

i agree with the both views .

Dr.Hamza Mousa

MedInformaticsMD said...

See "Sociotechnologic issues in clinical computing: Common examples of healthcare IT failure" at
for information of the sociotechnical challenges posed by healthcare IT.

These issues are the elephant in the living room mostly ignored by the "experts", especially in academia.