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Electronic Health Records and Hospital Quality: Reading beyond the WSJ headlines

Posted Feb 04 2011 4:10pm

In a late December Wall Street Journal article if you only read the headline, you would get the impression that the value of an Electronic Health Record is quite limited,  that the investment in technology in Health Care is not a good use of resources and that this conclusion is supported by noted researchers. BUT if you take the time to read the full article and the report it was based on, you might come away with a very different perspective.

The researchers themselves in the full article, indicate that there are 6 major limitations to their study. The key points being:

1)      The USA should ‘temper expectations for the pace and magnitude of the effects” of the governments incentive programs.

2)      Work needs to be done on how to measure the return on investment and quality

So we should not discredit the article, but should go beyond the headline to understand what the real issues are.

Observations from someone who has worked at implementing Hospital Electronic Patient Records:

1)      There are 3 key components to implementing these large systems: Technology, Process Change and Culture Change. The technology is the easy part. In the 1st 3 or 4 stages of the ENRAM model, we are providing the clinicians with tools and they are generally receptive (example PACS). These stages can be lead or directed by IT.

But as you move into Clinical Documentation, CPOE and Clinical Decision Support the baton must be handed to the clinicians to lead. This is their work that will change. Paper processes need to be redesigned to take advantage of what computers can do. Automating the paper process for the sake of automating is general a recipe for disaster.

Process Re-design and Culture Change are not areas where clinicians/physicians have expertise, experience and in some cases interest. It is not what they were trained to do. But to be successful going forward they need to be the champions.

2)      HIMSS has published in a number of articles that they have not seen significant ROI (quality or dollars) until Hospitals move to stage 5 on the ENRAM scale. The first 4 stages are about building the infrastructure.

3)      Understanding and articulating benefits is an area that needs significant work. The return in many cases does not come back to the organization that is investing, but to the system as a whole. Small organizations, at least in Ontario, have been criticized for making the investments.

4)      The small remote hospitals may see the most benefit as their patients often must be transported to larger centres for care or physicians come on a rotating bases to provide care.

In today’s world where time is of the essence and short fast communication is valued, take the time to read past the headline… the message is often much different than the few words used to capture our attention.

Resources Find the original online at the WSJ Health Blog HERE !
Find the full study at the American Journal of Managed Care  HERE !

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