Status of a US National EHR• US trails many other countries• US EHR IT spending < other industries• Impact on overall costs is unclear• EHR will improve health outcomes• Benefits ultimately outweigh the costs• ETA remains indeterminate
EHR vs. EMR• EMR = application that shares patient information within one health care entity• EHR = allows for health records to be shared across multiple establishments
EHR vs. ATM & RAND Study• ATM: initiated online banking revolution• EHR: can similarly transform health care• RAND: EHR will improve quality > reduce costs
EHR History• Originated in late 1960’s• Pioneers Weed, Barnett, & Warner• VA adapts EHR circa 1970s• IOM interest begins in earnest during 1990s
Objectives of EHRPrimary and Secondary Uses of an Electronic Health RecordPrimary Uses Secondary Uses Patient Care Delivery Education Patient Care Delivery Regulation Patient Care Delivery Research Financial & Other Admin Processes Public Health and Homeland Security Patient Self-Management Policy Support
Dissenting View• Increase provider reported services• Slow down patient provider interactions• Fail to improve provider to patient ratios• Persistent errors• Spending will not decline• Inconsistent quality
World EHRs• Australia, Canada, et al have interoperability standards• US does not yet have mandated standards• CCHIT is standardizing EHR functionality• HITSP is developing standards for interoperability• France, Sweden, et al collaborating to exchange EHI• Canadian EHR = many interoperable EHRs
VA EHR & EHR/HIE Workgroup• VA EHR > 1,000 VA healthcare facilities• EHR / HIE Interoperability Workgroup: 15 states, 19 EHR vendors, & 18 HIE vendors ~ 50% of the US population
EHR/HIE Interoperability Workgroup States EHRs HIEs California Alere Wellogic Alere Wellogic Colorado Allscripts ApeniMED Florida Cerner dbMotion Georgia Data Strategies GE Illinois DeFran Systems GSI Health Kentucky Dr. First Harris Maryland eClinicalWorks HealthUnity Michigan eMDs ICA Missouri Epic InterSystems New Jersey ePocrates Med3000 New York First Medical Solutions MedAllies Oregon GE Medicity Utah Greenway Mirth Vermont McKesson Misys Open Source Solutions Virginia MDClick OmniMD NextGen Optum Nortec Software Orion Sage RelayHealth Siemens
Challenges• Dearth of funding• Lack of medical staff support• Inefficiency• Difficulty creating a migration plan• Cost
Summary• US trails other countries• US EHR IT spending < other industries• Unclear if EHR will lower health care spend• Health outcomes will be improved• EHR benefits ultimately outweigh the costs• ETA remains uncertain
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