Electronic Medical Records: It’s Not too Late to Build the Tower on an Interoperable Platform

Tower of Babel by Sibeaster via Wikimedia Commons

Both the NY Times and the Boston Globe’s Health Blog, White Coat Notes , have recently run interesting articles on Electronic Medical Records (EMR). Both are based on articles published this last week in the New England Journal of Medicine. We’ve recently posted on the subject of EMR, and if you’d like some background information (as well as an introduction and a link to the pivotal work of Professors Sharona Hoffman and Andy Podgurski) you can find it here: Electronic Medical Records: How to Prevent the Creation of a Costly High-Tech Tower of Babel.

The first NEJM article, Use of Electronic Health Records in U.S. Hospitals, Ashish K. Jha, M.D., M.P.H., et al., was financed by the federal government and the Robert Wood Johnson Foundation and was based on a survey of nearly 3000 hospitals. The report, described by the Times as “the most definitive measure to date of the use of computerized patient records by hospitals,” shows that

…only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems.

A further breakdown of the components which constitute “comprehensive” and “basic” can be seen here.

Prior to this study, the numbers, based on what Steve Lohr of the NY Times described as “less rigorous studies,” were thought to be higher. The authors of Use of Electronic Health Records in U.S. Hospitals conclude that

The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.

Perhaps the good news here is that the relative scarcity of EMR implementation thus far means that we can yet still devise an interoperable system without rendering substantial but incompatible investments obsolete. Which is to say that we are not yet too far down nine different non-intersecting roads and that “a communicative Tower” can still be built, and sustained, on a Platform.

No Small Change for the Health Information Economy

Interoperability brings us to Elizabeth Cooney’s thoughtful and succinct post in the Boston Globe regarding the other NEJM article,  No Small Change for the Health Information Economy, Kenneth D. Mandl, M.D., M.P.H., and Isaac S. Kohane, M.D., Ph.D.

As do Professors Sharona Hoffman and Andy Podgurski, the authors of “No Small Change…” stress the need for flexibility, interoperability, liquidity of information, and the ability to substitute technologies as the need arises.  To do this they propose governmental encouragement of the use of a platform with interoperable applications (blog builders, think: “plug ins” and “widgets”)  In a recent post we noted that

In the words of Dr. Farzad Mostashari,  an assistant commissioner in New York City’s health department and head of the much heralded Primary Care Information Project (which is functioning as a sort of I.T. Department for many of the City’s doctors using EMR),  “There’s no way small practices can effectively implement electronic health records on their own. This is not the iPhone.”

Mandl and Kohane suggest that it should be. They make apt comparisons to the iPhone and ATM machines. Elizabeth Cooney’s article, “Health IT can learn from the iPhone and ATMs,”  explains the comparisons quite well and is well worth the minute it will take to read– and if you have another three minutes, I highly recommend you take a quick look at Mandl and Kohanes’ brief but important article. There’s a link to it here, and there’s one in Elizabeth Cooney’s article also.