The news is grim on electronic health records (EHR). A recent Harvard study, published in the April issue of Health Affairs, revealed that hospitals with e-health records systems aren't doing that much better-if at all-than those without EHR.
InformationWeek reported on the EHR study this week, and noted these dismal findings:
Dr. Catherine DesRoches, the Harvard assistant professor of medicine who oversaw the study, did caution that it may just take time for the benefits to become apparent. And the study was not without some hope. As IT Business Edge's Carl Weinschenk points out:
"Elsewhere in the study, however, it becomes clear that the point isn't that EHR is ineffective, which may seem to be the conclusion if the bullet points are considered in isolation. EHR will help-but only if used correctly. ... In other words, all the technology won't do much good unless the humans using it know what they are doing."
Even so, the technology situation in and of itself is worrisome. It would've been nice, for instance, if the study could have identified a best-practice for EHR implementations-something along the lines of the lessons-learned from Kaiser Permanente - but it didn't.
And I'm not really surprised that it couldn't. Integration is a huge issue with electronic health records, so I've tried to follow it, and frankly, it worries me that so many data experts stand aside, shaking their heads, like a 1980s, good-ole-boy mechanic, trying to diagnose their first import car.
Not that I blame them. Electronic health records is the Godfather of IT challenges: Tough, merciless and mean. Burton Group senior analyst Joe Bugajski called it "the biggest data integration challenge ever undertaken by the IT industry."
I think this comment from Informatica's Perspectives blog, which is attributed to Dr. Dominic Orsler, the IT lead and program director at Alberta Health Services, sums up the integration challenge well:
"... in contrast to other verticals that achieved impressive integration some time ago (e.g. Finance and Banking!), nowhere near as many dollars flow across Health integration enterprises and the whole issue is many orders of magnitude more complex and sometimes sensitive with regards to legislation and privacy than others. Moving basic numbers around a tightly controlled, private financial enterprise is just a teensy weensy bit easier than moving MRI results between independent health organisations and correlating them with a vast panoply of related information, including lab test results, pharmaceutical information, chronic disease management histories, discharge summaries, referrals, encounters, etc, etc, etc!"
Orsler left that remark on a post by John Schmidt, who suggested that health care might benefit from lean integration principals. He also mentioned that companies trying to build ICCs could learn a few lessons from Health Information Exchanges, which he compared to ICCs. Orsler begged to differ, contending that many of these Health Information Exchanges falter due to poor integration practices:
"In the worst case hypothetical scenario, integration becomes ad hoc, siloed, disjointed and sometimes just plain dangerous. Changes are made unilaterally and not communicated at various stages along the integration pathway, sometimes manifesting themselves at the physicians' desks, at which point it is retrospectively hoped they have had no major impact on patient safetya nd they get fixed, at best resulting in exasperated and worried physicians, at worst with harm done to patients. ... HIE's badly need ICC's to centrally manage and coordinate integration to ensure patient safety is never compromised by unilateral, mis-communicated changes."
Overwhelming, isn't it?
It's a well-known rumor in the tech press that health care IT is a separate beast, that has long done its own thing-which is why, until recently, no one really wrote about it except for niche journals. And I'm guessing that medical IT-the part that deals with administration, not the actual medical technology-needs to jump at least a decade, just to catch up.
But they're expected to do more than just "catch up" to the modern enterprise-to meet the nation's demands, health care IT will need surpass most organizations, and do so economically and efficiently.
Is it possible? I don't know, and nobody else seems to, either - which makes me think the unfortunate and unavoidable truth is that expensive, career-ending mistakes are going to be made as health care IT tries to modernize.
If integrated electronic health care records are to become a reality, it will certainly require identifying and adopting best practices-such as ICCs. Schmidt believes there's a lot to learn from lean practices, and he points out that others do as well-in fact, the first Lean Healthcare Transformation Summit will be held this year, June 9-10, in Orlando.
Let's hope he's right.