According to a 2008 National Center for Health Statistics report, 38.4% of physicians report using some type of EHR. Only 4% of the total reported using fully functional systems. 4% – let that sink in. (Source: CDC.gov)
Now, maybe I’m being harsh. Maybe I’m jumping the gun. Maybe “fully functional” is so advanced that it’s unreasonable to expect a large user base. Let’s see what “fully functional” is described as:
- patient demographics (sounds like a facebook profile)
- problem lists (sounds like facebook profile info)
- clinical notes (sounds like a facebook friend’s comments)
- medical history and followup (sounds like a record of facebook friend’s comments)
- orders for prescriptions (sounds like ordering a virtual good on facebook)
- orders for tests (sounds like a survey poll on facebook)
- prescription orders sent electronically (sounds like a message sent on facebook)
- test orders sent electronically (sounds like a message sent on facebook)
- viewing laboratory and imaging results (sounds like uploading photos to facebook)
- electronic images returned (sounds like uploading photos to facebook)
- warnings of drug interactions or contraindications (sounds like a birthday reminder on facebook)
- out-of-range test levels (sounds like a fancy term for something you could surely do on facebook)
- reminders for guideline-based interventions (sounds like a birthday reminder on facebook)
If 99% of EHR functionality seems to be built into facebook in some form and people agree that EHR will improve medical outcomes and reduce costs (which they generally seem to), what is taking us so long?
Google health does some of this – but certainly not at all. And it seems 100% patient focused, rather than provider encouraged. Microsoft HealthVault is probably similar (I’ll post an update later, but it crashed when I tried to create a new account) – sounds like a metaphor to me.
It is so frustrating to read anecdotes like this (makes me want to pull my hair out):
IMAGINE A PORTABLE, LOW-INTENSITY X-ray machine that can be wheeled between offices on a small cart. It creates images of such clarity that pediatricians, internists, and nurses can detect cracks in bones or lumps in tissue in their offices, not in a hospital. It works through a patented “nanocrystal” process, which uses night-vision technology borrowed from the military. At 10% of the cost of a conventional X-ray machine, it could save patients, their employers, and insurance companies hundreds of thousands of dollars every year. Great innovation, right? Guess again. When the entrepreneur who developed the machine tried to license the technology to established health care companies, he couldn’t even get his foot in the door. Large-scale X-ray equipment suppliers wanted no part of it. Why? Because it threatened their business models.
What happened to the X-ray entrepreneur is all too common in the health care industry. Powerful institutional forces fight simpler alternatives to expensive care because those alternatives threaten their livelihoods. And those opponents to low-cost change are usually lined up three or four deep.