Tuesday, January 1, 2008

Merry Go Round or Roller Coaster??

Happy New Year to all.

2007 was a year of up and downs for RHIOs and EMRs in the United States. A small number of RHIOs have made some progress and some group practices and hospitals have adopted or are moving toward  EMRs.  Many RHIO efforts have stalled due to lack of stakeholder enthusiasm.

Analysts like to point out how far behind the U.S. lags in EMR implementation.  Their statistics are flawed and reveals how statistics can be manipulated to prove almost anything.

First of all European nations have healthcare systems which are much more socialized and run by central governments.. If one analyzes their EMRs, they are focused on complications, adverse reactions and limited to primary care.

This article from Health affairs expands on my statements:


""UK practices best for IT to track medical errors

20 Nov 2006, e-Health Insider Primary Care

GPs in the UK are well ahead of colleagues around the world in having information systems which track medical errors, according to a survey of primary care doctors in seven countries.

The survey of primary care doctors’ office systems in seven countries, the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, reveals striking differences in primary care practice internationally.

Family doctors in Holland are the most likely to have systems that enable sharing of records electronically with other clinicians and New Zealand doctors were the most likely to say that they can access records when outside the office although even in New Zealand only one-third reported such access.

A total of 79% of UK GPs questioned for the survey reported that they have systems to document all adverse events compared with 7% to 41% in all other countries. More than 6,000 physicians took part in the survey from Australia, Canada Germany, Holland, New Zealand and the US as well as the UK.

The study found that Canadian and US primary care physicians lagged well behind doctors from other countries in terms of access to electronic medical record (EMR) systems. Top performers were again Holland where 98 % of family physicians said they use EMRs followed by New Zealand (92%), the U.K. (89%), and Australia (79%). A total of 42% of primary care physicians in Germany said they used EMR compared with only 28% of US doctors and 23% of Canadian doctors.

Canadian and US doctors were also the least likely to have systems that provided decision support. Only 10% of Canadian doctors and 23 % of US doctors receive computerised alerts compared with 93% in the Netherlands and 91% in the UK. At least two of five US and Canadian doctors also find it "very difficult" or "impossible" to identify patients overdue for a test or preventive care, versus one out of five or fewer in the other countries.

The researchers commented that while Germany and Canada lag behind the leading countries on EMRs, each has national plans to move forward. Germany is planning an “e-health smartcard” capable of including information about medications, allergy and blood type and Canada working on a project to link clinicians and provinces across sectors.

The researchers state that to date the US has built IT capacity by relying mainly on market-driven individual care systems such as Kaiser Permanente or that developed by the US Department of Veterans Affairs, together with physician investment. They add: “The United States appears to be the only country without a national plan to support expanded primary care IT capacity. “

This last statement is flawed and untrue. By order of the executive branch of the United States,  ONCHIT (The office of the National Coordinator for Health Information Technology) was established in 2003.  Congress has mandated Health IT, but has failed to fund it for several years.

The "Golden Rule" applies here.  "He who has the Gold rules!!"

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