IT systems ought to focus on patient needs first
WHILE PRESIDENT BUSH'S recent focus on electronic medical records (EMR) has brought widespread attention to the significant role that they can play in improving healthcare, we must be careful not to overlook current shortcomings if we are to transform this vision for the future into reality.
Specifically, a nationally led effort must strive to address specific concerns that other organizations by themselves cannot address.
We must look to leverage today's current systems with an enhanced infrastructure that will transform these hospital-centric approaches into a system of interlocking, patient-centric systems that provide long-term, portable coverage for all Americans. Beyond better serving the needs of patients, such an approach will also yield the equally exciting ability to track large populations for the long-term, which could help researchers identify trends in disease as well as risk factors that contribute to disease. Taken together, these two objectives represent the most significant goals that a nation-wide system could achieve.
Current systems have begun to see widespread adoption amongst both individual practices and healthcare facilities as working digitally offers a number of distinct advantages over paper files. For example, EMR systems can be based on the kind of medicine a physician practices so it can be optimized based on specialty with unique workflows. An electronic system with simple codes for billing, prescriptions and test orders can eliminate five to ten minutes of time per patient, allowing doctors to offer better, faster, more accurate care. Many systems can interface with a physician's billing software, eliminating the need for even more paper.
Ultimately, these systems focus on the needs of the healthcare provider rather than the patient. While this yields some significant, but momentary benefits for the patient, their primary benefits are delivered to the institution. So, even though these systems facilitate better care within one facility, they aren't perfect because they aren't portable. A better EMR system might focus on a patient instead of a clinic or hospital.
If a patient visits a specialist with an EMR system, their primary care physician can't access that information to assimilate it into his or her records. That means doctors have to trust the patient to provide specific updates to their medical histories during each visit. If a patient changes doctors, the new physician has to trust the notes of the previous physician and, if the notes are handwritten, hope that they are legible. Plus, with a large number of potential vendors, there's no guarantee that any electronic records are portable, which could mean extensive data entry at a doctor's office. While current EMR systems on the market have tremendous potential to reduce risks and errors, they are hospital centric and aren't providing the end value that patient-centric systems could provide.
Conversely, the Military Health System is in the process of deploying a truly patient-centric system. With records stored in a central repository, Composite Health Care System II (CHCSII) provides access to authorized users around the world. In an extremely mobile population like the military where beneficiaries can travel for training or combat and relocate often, health care and health record portability become a must-have, and the lessons learned from the Department of Defense's efforts can transfer to the private sector.
The military has had an EMR system for many years, but the first version, CHCSI, was facility-centric. Each military hospital selected its own system, and the systems weren't connected to one another or very compatible. In fact, there were over 60 disparate systems that comprised CHCSI. Finally, they realized that a system focused on patients instead of clinics would provide even greater advantages than the ones they were seeing with CHCSI. Currently under deployment, CHCSII addresses more than its predecessor by allowing military personnel access to life-saving information from anywhere in the world.
While MHS' decision to deploy CHCSII was driven by the need to provide the best possible care for its highly mobile population, it also delivers a significant benefit in providing researchers with aggregated information on over 9 million Americans. Using this resource, clinicians can track long-term healthcare trends within the largest available information base for the U.S. population.
The President has issued a nationwide call for EMR as a core component of improving our healthcare system through reduced costs and enhanced access to information, and as a result, it is up to us to respond with an approach that truly address nationwide concerns. The most important component of any eventual system will be its portability and transferability, facilitating better health communication, and therefore better health care, among doctors, patients and facilities.
Larry Albert is senior vice president of Integic's health care practice.