http://www.time.com/time/health/article/0,8599,1887658,00.html

Electronic Health Records: What's Taking So Long?

Prescription pads, clipboards and patient charts are so 20th century. In the era of CT scans, gene-splicing and stem-cell breakthroughs, handwritten record-keeping feels about as outmoded as the fluoroscope. It's more than just strangely retro; it's fantastically expensive

Health care in the U.S. costs a jaw-dropping $2 trillion annually, or more than $6,600 for every man, woman and child in the country. Streamlining the industry by eliminating medical errors, labor costs and general clunkiness caused by paperwork alone could save an estimated $300 billion each year, according to the national coordinator for health information technology under former President George W. Bush. The consensus, of course, is that we must go paperless: link hospitals, doctors' offices and clinics via an interactive digital grid that allows patient histories, test results and other data to be called up at a keystroke and transmitted anywhere. Hospitals have been slowly converting to electronic health records (EHR) for several years, but with health-care reform, at last, high on Washington's to-do list, President Barack Obama has called for $19 billion in stimulus money to speed up the process. Before policymakers can determine how best to spend that money, however, they need to know how the digital switchover is going so far and what's holding things up. (Read about why going digital may increase health-care costs.)

That was the goal of a study published March 25 in the New England Journal of Medicine, led by a team of researchers from the Harvard School of Public Health and Massachusetts General Hospital. What the investigators found was not encouraging. Currently, only about 1 in 10 hospitals nationwide has adopted even basic electronic record-keeping — and when you look inside that one statistic, the situation gets bleaker.

The investigators began by sending questionnaires to roughly 4,500 general hospitals around the country, asking about their use of 32 different features of health information technology — including electronic patient histories, doctors' notes, lab and X-ray results, prescriptions, drug alerts and nursing orders. "We sent out the survey to the hospital CEOs," says health-policy expert Catherine DesRoches of Massachusetts General Hospital, who participated in the study, "and about 63% responded." (Read "The Move to Digital Medical Records Begins in Tampa.")

Not many of those 3,000 respondents had much they could boast about. Only 1.5% reported having a comprehensive EHR system in place in all clinical units. Another 8% to 11% had a basic system — defined as having eight to 10 of the 32 possible EHR functionalities in at least one unit of the hospital. Even one of the most straightforward functions — computerized drug-prescribing — had been implemented in just 17%. Physicians' notes — which can be confusing at best and flat-out illegible at worst — had gone digital in just 12%. The only bright spot in the findings was computerized results-viewing, which allows doctors and nurses to call up lab results onscreen instead of having to wait for them to be delivered by hand; that time-saving upgrade had been implemented by more than 75% of the hospitals surveyed.

"That suggests that we do have a good place to start," says lead author Dr. Ashish Jha of the Harvard School of Public Health. Capitalizing on that start, however, requires identifying the main factors that are stopping hospitals from adopting EHR, and Jha and his colleagues tried to do that as well.

The biggest obstacle — no surprise — was cost, cited by 74% of the hospitals that hadn't gone digital. A small hospital might have to spend a few million dollars to buy and install new technology; a large one could require hundreds of millions. And more than 30% of hospitals had doubts about ever getting a return on that investment. The government's bailout money helps, but $19 billion divided among just the 3,000 hospitals that answered the survey would mean a little more than $6 million apiece — plenty for some, not nearly enough for others. 

Another major obstacle was simply resistance from physicians. Harried doctors, who barely have enough time to see all their patients and manage all their cases, do not want to bother with the added chore of learning a new computer system, no matter what the promise of its virtues. Past research suggests doctors are afraid that EHR could reduce their clinical productivity.

"Change is hard," says John Glaser, vice president of Partners HealthCare System, which responded to the survey. "Human beings struggle with that, and physicians are no different."

But most human beings can be persuaded, especially with cash. The study found that among hospitals that had implemented digital records — which tended to be teaching hospitals and larger hospitals in urban areas — 82% had received additional reimbursement for EHR use, and 75% got financial incentives for adopting the system. It also helped to have adequately trained staff and available tech support, which the authors suggest we'll need more of to make progress — particularly when it comes to the exchange of health information between hospitals. Try getting any two offices in any industry to integrate their computer systems so that all the software can talk to all the other software, and now imagine doing the same thing over a network of thousands of hospitals.

Of course the larger, more immediate problem is the 47 million or so Americans who lack any health insurance or access to health care and the other 250 million who struggle with care that keeps getting more expensive and less efficient. No one would argue that electronic health records alone will fix that, but few people deny that it's a critical first step. "It will require a whole lot of leadership and a whole lot of skill," says Glaser. Americans demanded no less when they went to the polls in November. Now it's up to Washington to deliver.

because the software as it stands totally sucks.

I know because my mother works in a doctors office (i installed the software, and set up their network) and they went completely digital with "the best" software out there, and it blows. You lose a wireless connection temporarily, and you lose everything you just entered and have to do it again. It logs you out and you can't even view the chart you just downloaded onto your tablet PC. The software that is available has no fault tolerance, and is very restricted.

If you have 2 monitors, you have to use the main monitor for all your medical software since pop-ups refuse to show on the second monitor.

I've heard stories of other medical software that if you use the mouse it will crash the software. So the techs tell the nurses to just use the keyboard only.

The software that is out there is strictly built for a 800x600 resolution monitor and doesn't scale. So you can only view small amounts of information at a given time.

Throw on that doctors I know don't even want to be bothered with any login information at all, you have no security and a nurse or even a janitor could just walk in and pretend she is a doctor and write scripts or modify patient files. You could overcome this with keycards (RFID tags) that you swipe for PC access, but that gets expensive.

When the software is that bad, I can completely understand why physicians would not want to move forward. I've considered building good medical software myself, but I'm not the type of person to risk everything I have to start a company.

Save who 300 billion? I am sure not the customer. That never happens.

Today there is no incentive to reduce the cost of healthcare. When you get sick, it does not matter to you what it cost.

Great that this saves money, however if what healthcare cost mattered to the consumer, everyone would be doing it, and the software to do it would be 100x better (as competition would create a need for it). Capitalism works. Healthcare in today’s market is not capitalism.

@ nordlead:

So people shouldn't have started using computers when the Pentium 1 came out because it was too slow? Electronics and software is an area where change can happen overnight. And the satisfaction rate of doctors who have made the switch is incredibly high if you look at the data. I don't think your anecdote is an accurate assessment of the situation.

@ mafoo

Spending excess money on healthcare is a drain on the economy. It is an inefficient use of resources that prevents long term growth. For a guy who loves supply side economics so much, you should understand better than anyone the value of investing in long-term growth. Giving these hospital economic incentives (like tax reimbursements) will benefit everyone in the long run. You are the one who advocates trickle-down supply-side economics more than anyone else. I don't really see how you can be against this.

And it would also mean lower taxes in the long run. Medicaid and Medicare are a huge part of the government's budget, and they will become an increasingly large percentage of the budget. Not fixing this problem would cost taxpayers more money.

And that's not even addressing the fact that insurance rates are already excessively high and even insurance companies are advocating for this change to happen.

Sucks that the hospitals are too stupid to realize how much cash they are losing.

Interesting that George Bush's national cooridinator for HC technology....Bush mentioned a few times that this was a major drain on hospitals resources.

I can only hope that some savy software providers work to create better software for the field...As I'm sure that the person that built the software will make a killing.

Akuma, if external groups, such as insurance companies are advocating the introduction of more electronic medical records....Why does the government have to push this, then? Why can't the insurance companies, in all their wealth, negotiate better rates in return for investment into E-records? Do we even know how much the government would have to invest to get this done? Why can't the hospitals do it themselves?

Electronic medical records also has benefits when it comes to going different hospitals, and stuff.

If I'm a regular patient at hospital A and I have a rare blood disease, and I go up to London where, shock and horror, I get stabbed (this is all hypothetical, I don't know much about medication - apart from its history, but that's a different matter) the hospital in London can just quickly bring up my details and know that I can't have some kind of blood transfusion because of my blood disease.

In terms to real-life, non-hypothetical situations, a few years back I was feeling some pain in one of my testicles (yes, yes, laugh), and so I went to my local GP, he said that I should go to the hospital, by the time I got to the hospital, they already had all of my details ready, including exactly what the GP had just diagnosed me with.

I don't think these situations would have been possible with a non-electronic system, or, at least, they'd be far slower/more impractical and probably more costly, too.

There are too many obstacles that have to be overcome for this to work:

-Cost
-Effort to learn something new
-Security

You argue about all of the long-term benefits but we all know human nature, it's hard to invest time and money into something that doesn't have an immediate payout.

I'm not saying they should never move forward, and I'm not saying you shouldn't start somewhere. I'm saying that they need to improve what is out there to acceptable standards, then people will be more willing to adopting it. If someone had enough capital, or personal dedication to produce good software that fixed the current shortcomings, then you could convince doctors to move forward. Also, the person who makes this wonderful software will make a lot of money.

Why should the government cut taxes to stimulate investment? Why should the government invest in military technology?  Why should the government offer grants to scientists to research diseases?  Why should the government build roads?  Why should the government offer financial aid to poor students?

I'll just be honest.  Sometimes the market can be slow, lazy, and resistant to change, just like people can be.  Insurance companies are passing along the higher costs to the consumer because they have too much favorable legislation passed for them that allows them to unfairly manipulate the market (although even this is coming back and biting them in the ass now since so many people are dropping their coverage). 

When something benefits both the public and private sector, I don't see the problem with government giving a little bit of a push.  I see you frequently advocate the government boosting the economy by cutting taxes very frequently by targeting certain tax rates.  The difference is minimal between this situation and that one.

But wouldn't giving money to hospitals specifically to use for this reason encourage programmers to develop this software?  When the private sector sees a way to make a profit, they will capitalize on that situation.  $18 Billion is a lot of money for someone who can write a couple thousand lines of code to modify a program that already does something substantially similar to what doctors need to work efficiently in the medical context.

And software can be written almost over night.  There are thousands of people on the internet who could write a program that would do everything hospitals needed in less than a week.