Getting to First Base
As all of us who work in healthcare know, we are all swinging for the fences to hit the home run of Electronic Health Record ("EHR") implementation. Practices and hospitals across the country are racing to make sure all of the myriad of boxes are checked, T’s are crossed, and I’s are dotted to be sure that their version of the EHR meets all of the new standards for meaningfulness. There are core measure items and menu measure items – pick all from column A and some from column B and you now have meaning. The search for meaning has been defined, but achieving it still seems a very distant reality for many of us that are just stepping up to the proverbial plate.
In the midst of this mad scramble toward meaning, two very different studies on IT were released this week. On Monday, a study was published stating that only “fully functional” emergency department EHR’s led to lower lengths of stay and lower waiting times. The study goes on to say that only 1.7% of the systems surveyed met the definition of “fully functional”. In fact, if you ended up in an ER with an EHR that was of the more basic variety, your wait time was likely to be longer than the majority of hospitals with no EHR at all. (A swing….and a miss.)
On Thursday an article in the Boston Globe's health blog, White Coat Notes, highlighted a new study being undertaken by the Emergency Department ("ED") in Boston’s MetroWest Medical Center. The program allows patients to text the ED to check on wait times. One of the goals of this program is to “promote better customer service” by decreasing waiting times. At the time of publication of the article, over 450 patients had sent text messages to the two emergency departments in the MetroWest system. The average wait time was 24 minutes to see a physician. (A bunt down the third base line…and he scores!)
Like many other parts of the new healthcare reform world, many of the goals may be admirable, but seem unobtainable and overwhelming to many hospitals and healthcare providers. Successful implementation of the EHR across the healthcare system may be the home run we are all looking for, but if we want to achieve true meaning for IT in healthcare, we may have to hit a few singles first.
I would say we need to ground out a few times and learn where the holes are prior to punching through those singles :-) The streets are littered with failed implementations... granted, there certainly are more than a few highly successful implementation stories out there too. But, alas, the devil is in the details. Successes like Mayo and Kaiser are likely (in some way) due to the captive PC or the employed physician model in place prior to adoption. Getting beyond the fact that the physicians IT expense was initially subsidized and maintained by the mother ship and the (salaried) docs didn't care about initial decrease in patient load during roll out---these variables all go towards improving chances of a successful implementation phase.
IMHO, the big issue is still the cost of the system for the average practice. Why should physicians alone shoulder the entire economic burden of an EMR roll-out initiative? Many downstream players benefit far more than the physician when electronic records replace fax machines and paper. Lab companies, third party coordinators, insurers and institutions all benefit when the data is transported electronically and "seamlessly".
Until a nationwide data IT network is functioning on the backend, we'll mostly be creating digital, tethered, and siloed cousins of the paper chart and the data contained will be nearly useless from a research perspective.
Please do NOT mis-understand me... I am fully in favor of having every single physician operating on an inter-connected, affordable, simple, intuitive electronic interface. Medical errors will decrease, costs should diminish as duplicative studies and treatment of errors are reduced. This pie in the sky system will also improve the delivery of care and standardization of care --- and patient access will improve accuracy of the data.... but as you state... this is quite a ways off---unfortunately.
Howard is correct ~ there will be grounders, pop flys, and some big swings and misses before we see much rounding of the bases. But the time has come to step up to the plate. It is time to drag the US healthcare system kicking and screaming into the 21st century...
Yes... Brian is correct. The time has come... all players need to be at the proverbial table, figure out how to capitalize the expense, build the infra-structure and roll it out. Sounds simple :-)