The Failure Of The British Electronic Medical Record
Posted May 22 2011 5:23pm
Stanley Feld M.D.,FACP,MACE
The development and use of an electronic medical record is extremely important for communication, rapid diagnosis and clinical decision making, increasing efficiency in working up patients, decreasing the cost of duplication of testing and time delays in medical care and treatment.
There are many other advantages of using a functional electronic medical records. A person could be anywhere in the world and have his medical information immediately available. The results of all testing should immediately be communicated to the treating physician. All imaging studies should be digital.
Patients’ physicians could immediately read and use them for their clinical decision making.
These are only a few of the advantages of the electronic medical record. During an office visit the physicians’ cost of removing a chart from the shelf, dictating a notes and pasting lab results into the chart is $7.75. Instant automatic noes and laboratory testing delivered to the chart by electronic medical record cost nothing.
Dr. Don Berwick the head of CMS loves the English system . England has a a single party payer system of socialized medicine. The healthcare system is controlled by the taxpayer-funded National Health Service (NHS). The NHS committed itself to installing a fully functional electronic medical record in 2002 with the goal to have it completed by 2005.
Only 44 of 250 big hospitals have received a partially functioning new electronic medical record system after trying for 8 years. While the installed systems have contributed some functionality they are not fully functional. They cannot fully exchange information.
The installations of EMRs have frequently led to initial chaos in hospitals. There are reports of lost patients, lost records, an inability of hospitals to be paid for the care they provide.
The scope of the program for developing a functioning EMR has been decreased as a result of cost overruns and missed deadlines. New EMRs for ambulance services and doctors offices have been eliminated.
There have been many unintended consequences, too numerous to list, in trying to implement the NHS’s goal for a functional EMR. The NHS has accomplished a few of its goals.
The NHS was the first in the world to replace X-ray film with digital images for scans and X-rays.
2. Half the country’s general practitioners, or family doctors, can now transfer at least some of their records electronically to another practice when patients move.
3.Electronic transfer of prescriptions to pharmacies is finally proceeding at pace.
4. Six million out of 50 million patients now have a summary care record. It contains a limited list of allergies and current medications. It makes emergency room care significantly safer.
The NHS has a long way to go and lots more money to spend if they continue the present course.
What is the solution?
Create incentives for patients to obtain their clinical information. Scan the clinical information into a thumb flash drive and carry the data on a key chain.
Create incentives for hospitals and doctors to open the thumb flash drives and use the data.
This would be an instant solution to a difficult problem. The system would reduce the cost of retesting.
EMR are too expensive for U.S. physicians . Physicians are experiencing reimbursement cuts. A fully functioning system costs more than $60,000 per physician. There are additional costs such as service and upgrade fees.
If a satisfactory EMR was available the government should buy it. They should put it in the Internet cloud. Upgrades should be installed as necessary. A single integrated healthcare system wide EMR would result. Physicians should be given incentives to use the EMR. They would be charged by the click. The cloud EMR must be integrated into a physicians’ present non functional legacy systems.
This process was used while converting to electronic billing in the 1980’s. It should be done with the EMR now. It will save everyone time and money and increase the ability to diagnose and treat patients rapidly.