Electronic Health Records Part II

Some notes from the writer, Andy Oram, of this O’Reilly Radar post when he attended the Massachusetts Health Data Consortium:

According to the president of the Massachusetts eHealth Collaborative, Micky Tripathi, 80% of US medical practices consist of just one or two physicians, and small practices handle 90% of all outpatient visits. Given the difficulties of electronic record conversion and the reluctance of doctors to put in the effort, only 1% of these practices currently use electronic health records.

I suppose that small practices may improve care the way small restaurants cook more gourmet food, but the structure of medical practices clearly reduces efficiency. But electronic records hold out hope as well. Doctors can use computer technology to accommodate their preference for small practices

Given the heterogeneous nature of the practices and the desire for doctors to not go through the headache of installing new systems on existing platforms, there seems to be a problem in getting them to understand the incentive for them to go through the process:

Tripathi made another impressive point: doctors don’t see the benefit to them in digitizing. In fact, they see it as benefiting everybody else but them. I think this is because they don’t know of any killer app that would make the change not only desirable but indispensable.

Another expert I talked to claimed that wouldn’t suffice. What doctors need is to be offered an array of useful applications that are guaranteed to work with the platforms they choose to install. This suggests that standardization is even more important than is usually thought, because it will create a platform for new applications.

His next point reiterates something we discussed when I brought up this issue last time: standardization.

First comes standard-setting. The most obvious role here is to promote standards that ensure the different systems adopted by different providers fit together. As reported by Ray Campbell, executive director of the Massachusetts Health Data Consortium, the Medicare/Medicaid part of the bill requires conformance to requirements that will force conversion. God is still in the (yet to be worked out) details concerning meaningful use.

Oram goes on to discuss the government’s role in pushing forward incentives for conversion and for working together. I agree. The masses have taken the anti-government stance of the hippie forbears in the 60s and tried to co-opt to protect the status quo (despite that status quo leaving millions underserved). If we can work worldwide on internet and other large complex standardization programs there is no reason why health care could not be aided by government, private, and public involvement in creating standards and implementing them for health records.

I think one of the things that holds people back is the need for ‘perfect’. They are looking for the ‘perfect’ solution or way to do this. There is no perfect, especially when it comes to computers and programming. You get a system that works as well as it can at the time and work to evolve it into a more powerful one. There is no black and white simple solutions which everyone seems to ascribe to our political situation – there is only starting out on a new enterprise and working to ensure that it is efficent, low cost, and provides the most for people.

Oran concludes:

The one thing of which I am convinced is that we need to replace the current adversarial model of allocating health money with a cooperative one. Only if providers and patients get lots of data, and are willing to use it creatively, can we lower costs.

I agree.

One Comment

  1. Ian

    It is pathetic how the benefits of the digital age haven’t been fully realized in medicine. The true benefits of digital technology include speed of transfer (internet), speed of calculation (processing), mass centralization (storage), and exact duplication of information. Imagine the power of combining medical records across all patients afflicted with a disease. You could determine better ways of understanding, diagnosing, and treating patients. Conducting epidemiological studies would be incredibly simple if you wrote software that could scan massive amounts of standardized medical records and sort it into relevant data.