24 Sep Global lessons: U.S. can learn from others in adopting electronic health records
Chicago, Ill. – The United States government and private sector payers must become more involved in the adoption of electronic health records if America is to catch up to adoption rates in leading nations, according to the co-author of a new global study of EHR adoption.
Steven L. Arnold, president and CEO of Healthcare Consultants International, believes the U.S. should adopt centralized governance, and the federal government should collaborate with state governments and mandate, if necessary, funding from payers.
In the U.S., the EHR adoption burden falls mostly on private sector healthcare providers. The American system does not have to be completely government-funded adoption, Arnold said, but commercial payers like health insurance companies have to be involved in the funding because they are one of the most important stakeholders, he said.
“Clearly, those stakeholders who have much to gain by adoption rates should be involved in the process, and that includes payers, something you don’t find in many countries of the world because the [only] payer is the government in many of them.
“Here, the government is a payer, and certainly the largest payer with Medicare, Medicaid, and the military, but we have large number of payers coming from commercial sectors and they have to become involved.”
Rating adoption
Arnold’s co-author in the white paper was Walter Wieners, managing principal of Walter W. Wieners Consulting. They co-chaired a 16-member task force of the Health Information Management and Systems Society that reviewed EHR progress in Europe, Asia, the Middle East, and North America, and produced a white paper titled “Electronic Health Records” A Global Perspective.”
The task force found “tremendous variability” in the use of health information technology within countries and uncovered lessons for the U.S., which tends to lag behind in EHR adoption.
Fully integrated EHR systems are defined as end-to-end systems of clinical patient records, personal health records, e-prescribing, and interoperability with lab and radiology systems. Under these criteria, the paper said EHR adoption rates among hospitals and physicians in most nations is not that far ahead of the U.S.
However, EHR and e-prescribing systems are sometimes used to measure adoption. Under these criteria, the top nations are as follows: United Kingdom, 59 percent; New Zealand, 52 percent; and Australia, 25 percent. By comparison, the U.S. rate is a relatively low 17 percent.
Approaches vary from country to country, and each has its own adoption problems. England, Canada, and Australia are among those with “top-down” government mandates, while Israel has developed a grass roots approach driven by competition in the private sector.
The HIMSS study credited England, which has committed $6 billion (Euros) over 10 years and might spend much more, for its willingness to invest in healthcare information technology adoption.
Arnold believes the United Kingdom has one of the most advanced EMR adoption programs because of its central approach, which features geographic hubs and spokes. The UK has achieved rapid adoption because the government, which is the single payer for the overall healthcare system, is paying for it through the National Health Service.
Wieners cited Canada’s “Health Infoway,” a national effort of 14 federal, provincial, and territorial government shareholders, as a leading model. By 2007, the Canadian government had invested $1.6 billion in Infoway, which features an independent corporation at the national level. The corporation, which operates separate from government, supports the decision-making, technology purchases, and planning and implementation of EHRs in each province.
“It’s different in the way governance and organization are structured,” Wieners noted.
According to Wieners, lessons learned from the global study also include:
- Building and maintaining genuine physician and clinician involvement in the political and implementation processes is essential to program success.
- Developing support from all stakeholders in the healthcare enterprise – national, regional or provincial governments, institutional and private providers, and the active engagement of the vendor community – is critical for the interoperability of HIT systems. (In the U.S., vendors are waiting for the government to establish standards for patient data exchange.)
- The need for national legal and regulatory agreement on privacy and consent issues related to electronic records is an essential component of national programs.
Wieners added that in the early stages of most programs, one common thread was that communication from all stakeholders led to major changes in how governments approached the implementation and adaptation of infrastructure that enabled EHRs. Australia, for example, looked at adoption as a federal top-down initiative with its respective states. In the reconfiguration of the stakeholders and the boards at the national level, states assumed the larger role and shared responsibility in the planning, development, and financing.
“Those revisions over the past couple of years has led to a more favorable environment,” Wieners noted.
In addition, the leading global programs all report that they underestimated the total level of effort required to manage change; as a result, more resources have been applied to that. “Ultimately, the implementation of complex applications, which actually changed the methods of clinical practice, does involve a lot of change,” Wieners said. “Those countries found that in the private sector, there were a limited number of resources that truly understood the clinical setting, electronic health records, and the process of managing people through change management.”
Healthcare benefits
To date, the authors note there have been few cross-national studies about EHR initiatives or fully developed programs, and they called for a more rigorous evaluation of both government and industry-driven EHR projects to address limitations in global knowledge sharing. After an analysis of Canada, Australia, and Great Britain found many common experiences, they also want a global observational study to gain more understanding of EHR benefits.
One of the purported benefits of EMR, and healthcare IT adoption overall, is that it can reduce the medical errors that drive up costs. Arnold, however, does not see a correlation between the rate of EHR adoption and controlling healthcare costs.
“I don’t think you can look at it that way because most countries in the world have not done a good job of controlling their healthcare costs,” Arnold said. “Just because you have adoption of electronic health records does not necessarily mean that they’ve eliminated unnecessary testing and things like that.”