EMR in the US

According to the Information Technology and Innovation Foundation only 28 percent of primary care physicians in the United States are currently using electronic health records (EHRs).  However, the February 17, 2009 signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act promises to change all that. The Congressional Budget Office estimates that 90 percent of doctors and 70 percent of hospitals will adopt comprehensive electronic health records within the next ten years as a result of the act.

Due to financial limitations, lack of confidence in overall effectiveness  and concerns regarding the proper implementation of EHRs use have seen slow growth in the United States. This is compounded by the government’s laissez-faire approach in regards to the adaptation of electronic systems. Lacking financial and informational resources as well as incentives physicians and hospitals have overwhelmingly placed the adoption of EHRs on the back-burner. However, the passing of the HITECH Act represents a fundamental change in governmental involvement in the issue and is indicative of a vast restructuring of U.S. health care as we currently know it.

Sweden is the world leader in EHR usage with 100 percent of primary care physicians currently using them.  Finland follows close behind with 99 percent and Denmark is third with 95 percent. This is the result of strong governmental involvement beginning in the mid-nineties pushing for entirely electronic health record keeping. In Denmark the process began with a federal mandate for the use of electronic prescriptions.  In addition, Danish law has required primary care physicians to issue referrals electronically to standardize clinical records for years.  Similarly, Finland has passed a law requiring the adoption of a national patient record system for all public and private health care providers by April of 2011.

Now, nearly two decades behind, the United States is attempting to get up to par with the rest of the word. The HITECH Act is a good start but in order to reform the current health care situation change must come on an individual level.

Doctors and hospitals in the U.S. bear the brunt of this change. With a limited amount of federal health IT mandates, rather than a platform of broad reform, individual health care providers are forced to decide for themselves what action to take. This will inevitably lead to a disorganized, decentralized system that will take further decades to compile into any sort of comprehensive, meaningful structure. The sheer magnitude of the health care system in the U.S. presents a complex problem when trying to determine a comprehensive solution.

In the United States there are approximately 1.5 million doctors and 5,700 hospitals. Networking the vast amount of information from each of these individual entities must come from a centralized, federal mandate. Dr. Chris Hobson, chief medical officer of Orion Health, the company that provided IT software solutions for New Zealand  (a country that currently has a national networked health care system) , suggests that in order for the U.S. to provide quality health care doctors must exchange patient data in the form of patient identifiers and e-prescribing systems. He also suggests that a national machine-readable patient ID card system could save $1 billion a year in administrative costs. However, current legislation does not provide the proper infrastructure to support this type of system.

A portion of the stimulus plan entitled the Recovery Act does contain $1 billion to encourage the adoption of health IT technologies in the U.S..  It does not, however, specify a centralized system, leaving individual doctors to decide for themselves what works best in hopes that it will be compatible with changes that will inevitably need to be made in order to collaborate with other health care providers in the long-term.This leaves health care providers feeling pressured to adopt EHR and IT systems that may be obsolete in the future if they are not compatible with whatever national system is eventual mandated.

Any sort of broad national reform, health related or otherwise, must be structured from the bottom up. The framework must be in place before any sort of real change can be made. Under the current system, the government is suggesting that doctors and hospitals partake in a “trial by fire” approach to reform. In order for any meaningful reform to take place, there needs to be a direct dialog between the government and health care providers and a single, comprehensive plan needs to be in place. If the U.S. wants to catch up to the leaders in modern health care we must follow their lead, learn from their successes and shortfalls and develop a strategy that is conducive to our own needs based upon their example.

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