On January 22 after two months of serious discussion (see here) the Dutch health minister Dr. Ab Klink announced in the Dutch parliament that the implementation of a national EHR will be postponed. He did not mention a new target date.
On November 1 the minister sent a letter to all Dutch households announcing the rollout of an EHR. Initially the discussion focused on technical and financial issues. But the accompanying brochure made it clear that all healthcare providers would have access to the patient data. This caused a major “uproar” from citizens. Within 2 months over 330.000 persons opted-out of a system that not even was legally accepted. As a consequence privacy and access concerns are now some of the major arguments for the postponement.
But also doctors and hospitals had strong objections, although with different arguments. As I have written on the Dutch EHR discussion site, it is a missed chance for which the official organisations are to blame. They never organised an information campaign to explain the concept of an EHR to either clinicians or patients.
However, it does not seem to be a Dutch-only problem. In Germany the introduction of the smart card has been seriously delayed, due to technical and security reasons. In the UK, one of the more advanced countries in the EU for implementation of a nationwide EHR system, serious safety and privacy issues are arising and the implementation has already a delay of over 2 years. The fact that on an almost regular basis electronic information is lost or stolen, doesn’t help either.
In the USA the discussion about the feasibility of a nationwide EHR started a couple of months ago. An article on EHR adoption in the NEJM showing that only
“Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system.”
Electronic Health Records in Ambulatory Care — A National Survey of Physicians
laid the foundation for that discussion, whereas an article in the Wall Street Journal on January 22 refueled it:
“Even where privacy concerns can be addressed and regional networks are up and running, there may not be enough technicians in many areas to rapidly install large numbers of electronic health record systems and train medical personnel to use them. The bill would provide funding to expand programs that train the technicians, but developing the training programs and getting people through them takes time. An unrealistically fast rollout could lead to unqualified technicians installing systems in ways that lead to frustration and backlash among doctors, warns Mr. Glaser, who serves on the board of the National eHealth Collaborative, a public-private partnership that aims to accelerate the development of health IT.”
Waste Feared in Digitizing Patient Records
The Health Care Renewal blog presented a very thorough insight reaction to this article (Waste Feared in Digitizing Patient Records: Wall Street Journal) focusing mainly on technical aspects.
Privacy is a concern too, as Kevin Pho pointed out:
“Balancing patient privacy with ease of digital record adoption is tricky. On one hand, it is true that these records may not protect patient information as securely as one would like. On the other, excessive safeguards will hinder patient care, which is a supposed strength of electronic systems.”
Could privacy laws and bureaucracy derail universal electronic health records?
And a recent software problem in one of the oldest and most respected systems in the USA did not help either:
“Patients at VA health centers were given incorrect doses of drugs, had needed treatments delayed and may have been exposed to other medical errors due to the glitches that showed faulty displays of their electronic health records”
Veterans exposed to incorrect drug doses
BTW on PHR level the uptake is not enormous either, Modern Healthcare in September 2008:
40,000 patients at Beth Israel Deaconess have PHRs, but only 42 patients have added any information to those files, Halamka says.
Data privacy concerns remain as Google PHR grows
See also: PHR Platforms Race: HealthVault Updated, Consumer Interest Still Unproven
Maybe the European Commission is correct in its prediction that:
“[...] achieving full implementation of electronic health record (EHR) systems across Europe, may take another 15-30 more years to achieve. “However, my bet is to be there before we go to Mars,” says Iakovidis, referring to the mission slated for 2033.”
Electronic records before man on Mars
What has to be done to make a nationwide (global?) EHR a feasible project?
- Reconsider the technology?
- An even more global approach to standards?
- A rigorous reform of healthcare systems and infrastructure to pave the way for an EHR?
One thing is clear, we are dealing with a serious paradigm shift in how we deal with healthcare, a shift that is going to happen, due to the developments that led to the information and knowledge society concepts. Web 2.0, Health 2.0, the informed patient, participatory care, it is all here to stay.
Your reactions would be appreciated.
Lodewijk Bos
Kudos to Dr.Klink for awakening from his dreams of IT, just in time to save hospitals and the Dutch system of medical care from meltdown.
The privacy breaches engendered by these EHR devices are epidemic and the degree to which these devices and electronic ordering systems endanger patients and diminish outcomes is formidable but never scientifically determined. Even the paradigm shift needs to be scrutinized as to whether there are bonafide long term benefits or is it the dream work of HIT zealots, dreamers, and a few political lobbyists.
NZ
“Even the paradigm shift needs to be scrutinized as to whether there are bonafide long term benefits or is it the dream work of HIT zealots, dreamers, and a few political lobbyists.”
As a medical informaticist, I always viewed clinical IT as a tool to aid health care ENABLERS (physicians, nurses, etc.), not a tool to slow them down to provide data for facilitating health care facilitators (SUPPORT personnel and payers) in addition to “REVOLUTIONIZING” medicine (whatever that means). The latter is a term of bellicose grandiosity clearly coming from starry eyed zealots and opportunists.
I am a physician practicing in the USA. As I understand it from colleagues who have practiced abroad, we in the USA go overboard in documentation, probably because of the massive lawsuits and threats of lawsuits we labor under. This is also consistent with what I find when I review medical records, which is that >90% of the info in the medical record is useless. What an MRI showed five years ago, for example, may be helpful. What a patient’s temp or weight or her subjective rating of her degree of pain after a surgery was, on the other hand, is of virtually no use to her later caregivers. The MAIN issue for us here in the USA continues to be CO$T, and IT does not contribute to making healthcare less expensive. Indeed, it just makes it even easier to continue to waste money.
I am a health information management consultant in the US. This is very interesting to find that other countries are putting the electronic health record on hold. I have been working on several task force to make interconnectivity happen from state to state so I can understand the frustration. Another interesting note was about the amount of PHR (40, ooo patients have them) and yet so many are not using them. I agree that we will make the transition to the electronic health record because we have all the elements that you spoke of. We are all working in the right direction.