Tuesday, March 9, 2010

Electronic Health Records Use by Hospitals and Doctors

Great in Abstract Theory , Small in Concrete Practice

There’s a story of a husband and wife watching their children play in the newly laid concrete sidewalk. The husband is furious, screaming, red-faced, facial veins bulging. The wife says, “But Dear, I thought you loved children.” The husband replies, “ Yes, in the abstract, but not in the concrete.”

Electronic Health Records are like that. In the abstract, government officials love EHRs , but in the concrete world of practice, few hospitals and doctors use them, and even when they do, hospital and doctor EHRs rarely speak to one another.

Here is David Blumenthal, MD, National Coordinator of Health Information, speaking in the abstract He is responsible for implementing the government’s HITECH Act, designed to put EHRs in every doctor’s office and every hospital’s clinical unit.

This is a eloquent abstract statement, but as yet HITECH is failing to move health professionals to make concrete moves,

“Information is the life blood of modern medicine. Health Information Technology (HIT) is its circulation system. Without that system, neither individual systems nor health care institutions can perform at their best or deliver highest-quality care, any more than an Olympians can excel with a failing heart.” (1)

Then comes Blumenthal’s concrete conclusion,

“Yet the proportion of U.S. health care professionals and hospitals that have begun to transition to a electronic health systems are remarkably small.”

Blumenthal then cites two NEJM articles indicating only 1.5% of U.S. hospitals had comprehensive electronic records (i.e, present in every clinical unit), and only 4.0% of physicians reported having an extensive, fully functional electronic-records systems, (2,3),

The common denominator for hospital and physician resistance was the capital required for implementation and maintenance. Physicians feared a permanent loss in productivity and a disruption of practice flow.

To overcome this resistance, the government is promising generous bonuses to hospitals and doctors for implementing systems, with hospitals being given additional monetary incentives to help doctors install systems that interact with hospital systems.

There are signs government incentives may be working. Today I received this press release from MedCity, Inc. a company helping hospitals install EHRs.

March 9, 2010- Medicity, Inc. announced today that top-ranked health system Trinity Health, comprised of 44 hospitals and healthcare facilities in eight states, went live with the first stage of its Novo Grid deployment - establishing electronic health information exchange (HIE) with 297 affiliated physician practices and 991 physicians in three months.

The patented Grid technology distributes patient information directly to computers at the physician practice. Medicity's streamlined deployment technology and processes facilitated this rollout on a mass scale.

The Novo Grid will improve patient care coordination by offering community physicians secure, real-time electronic access to the health system's clinical data. The Grid deploys intelligent software agents that enable physician offices to receive patient information directly into an electronic health record (EHR) or, for paper-based practices, into an electronic "dropbox" accessible via a standard web browser.


If you are a physician interested in installing a system in your office, you may want to talk to your local hospital about its plans for implementing a system for its medical staff.


1. Blumenthal, D, “Launching HITECH,” NEJM, December 30, 2009.
2. DesRoches, CM, et al, “Electronic Health Records in Ambulatory Care – A National Survey of Physicians,” NEJM, July 3, 2008.
3. Jha, AK, et al, “Use of Electronic Records in U.S. Hospitals, “ NEJM, April 16, 2009.


Beth said...

Government subsidized EHR may make it seem as though installing this technology provides a net increase in efficiency----but it falls under the auspices of focusing on the "seen" while ignoring the "not seen."

What more highly valued innovations, goods and services are not available because of the loss of wealth through government redistribution? We will never know because they lie within the "not seen."

What Is Seen and What Is Not Seen by Frédéric Bastiat

Richard L. Reece, MD said...

Thank you again, Beth, for your insights. What you are saying is that information technologies has unforeseen and adverse consequences. Redistributing wealth and information has consequences - not all of them pretty. Readers of my blog should visit Beth's blog, which you can find by clicking on Beth.