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The number of successful EHR implementation have been accompanied with a comparable number of EHR failures.  UCSF is one of those example where the grand vision of and EHR system was started five years ago was eventually scrapped.  How can health care industry ensure a better EHR success rate?

According to Patty Enrado:

The most important thing that the EHR/EMR market can do for itself is to be transparent. If there is no transparency, how can healthcare systems perform accurate due diligence? There’s a business reason for non-disclosure clauses in sales contracts, which prevent purchasers from reporting problems with the health IT vendor or their products, and “hold harmless” clauses, which exempt vendors from any liability. It may guarantee a risk-free business environment for the health IT vendor, but it hurts the EMR market and eventually hurts the health IT vendor’s reputation. Clinicians and healthcare organization executives may be obligated to remain silent about the product and/or the vendor’s problems, but they will talk informally to their counterparts in other healthcare organizations. You’ve heard the complaints. You know which health IT companies did what to whom.

In addition to being transparent, I would also argue that a well thought out plan should be in order before the start of implementation. A list of who has access to the data collected and what kind of reports will need to be build. I have seen cases where the cost of implementing an EHR system shot up dramatically because of the lack of a well define advance plan.

Not sure what to make of the latest video regarding the cost of dying.  The fact that we are spending 50 billion a year on patients last few months of their lives as the majority of them spend the time in intensive care unit.

I would much rather die at home rather than spend the last few months of my life in intensive care unit.

Security plays a crucial role in EHR systems that differs from other traditional software.   As successful as the Veteran Affairs have been with their custom created EHR system, security is still an issue.

The Veterans Affairs Department has problems fully protecting its networks while also maintaining network links with proprietary medical devices, according to senior VA officials.

The medical products and devices, including monitors and sensors, are regulated by the Food and Drug Administration. Their design and operation cannot be modified by the end user.

Network engineers are often blocked from using network security tools on the medical devices, Roger Baker, VA’s chief information officer, and Steph Warren, the department’s principal deputy assistant secretary for the Office of Information and Technology, said in a statement issued at a federal health IT panel meeting Nov. 19.

Network security is one that definitely need to be addressed in the world of EHR.

The standard for recognizing EHR success and “meaningful use” have been confusing for all the parties involved.  Hospitals wants to ensure they are purchasing standard EHR so they can receive the Federal stimulus money.  The vendors want to make sure they meet so the standard so they are competitive.  Finally it seems like people are recognizing the need for a simpler standard.

“I think we have a basic set of requirements, and there may be some polish done to them based on the comments and principles. We’re just beginning the directional cycle for 2013 and 2015,”

Although the standard is just starting to be written, it is crucial the standard is well define as it will have an impact in the coming decades in the field of EHR.

With all the money that has been poured into EHR system there will be a lot of research regarding how efficient EHR systems are and how much improvement EHR system provides.

From the article:

For the heart failure category, the researchers found that:

• Hospitals with advanced EHRs met federal standards 87.8% of the time;
• Hospitals with basic EHRs met the standards 86.7% of the time; and
• Hospitals without EHRs met the standards 85.9% of the time.

The researchers also found that the average length of a hospital stay was:

• 5.5 days for hospitals with advanced EHRs;
• 5.7 days for hospitals with basic EHRs; and
• 5.7 days for hospitals without EHRs.

Technology does not improve the quality of hospitals automatically. However, it does allow hospital workers a more efficient way to monitor and tract their patients. Nevertheless, expect these kind of efficient study to continue.

If there were any cautionary tale regarding EHR it is the example from the British government.  After allocating 12 billion pounds to build an EHR, the system has been beset with problems and is four years behind schedule.

The record will officially go live on Thursday.  Hopefully all the privacy issues described in the article has been hammered out.  Keep your eyes open on British government as they will be a good indication of positives and negatives of an EHR system.

In a recent study by Kaiser,they found that:

Aggressively managing patients at risk for osteoporosis could reduce the hip fracture rate in the United States by 25 percent, according to a Kaiser Permanente study published in the November issue of the Journal of Bone & Joint Surgery. The first step must be a more active role by orthopedic surgeons in osteoporosis disease management, researchers say.

With Kaiser’s Health Connect, which is dubbed as the largest civilian EHR system, Kaiser is in a much better position to run different kind of study to help prevention of diseases and illness.  Base on the Kaiser’s study, they are able to treat a much higher percentage of patients in comparison the national average.  Even though Health Connect cost much higher than what was initial planned, it can payoff in a big way in preventive medicine down the road.