Electronic health records are wrong prescription for automation

“I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the Earth.”

—President John F. Kennedy

Imagine if President Kennedy in his famous speech didn’t stop at this point.

Instead, he started describing the rocket.

Assume he demanded a rocket with only two, or maybe four stages; that he insisted on a specific type of fuel, or certain weight and speed.

Would the American space program have succeeded? I doubt it, and you should too.

The Obama administration’s plan to spend $19.2 billion on electronic medical records as the sole path to achieve health care automation is the equivalent of Kennedy dictating to NASA the specifications of the rocket carrying Neil Armstrong to the moon.

Health care automation is the new national project for good reasons.

Americans spent $2.7 trillion on health care in 2007, or $7,900 per person.

The U.S. Department of Health and Human Services projected in a recent report that health care expenditures will reach $4.3 trillion by 2016.

The administrative cost alone of health care delivery was 31 percent of the total cost, and expected to reach $1.29 trillion by 2016, according to the same report.

While the U.S. health care cost per capita is the highest in the developed world, Americans lag in all related statistics such as life span, infant mortality and number of uninsured.

The American government is a major consumer of health care through Medicare, Medicaid, government employees’ plans and many other programs, so it has a major stake in cutting costs.

The focus on health care automation to squeeze excesses and improve quality is the right goal.

However, forcing an electronic health record system as the pathway to reap the benefits of automation represents a total misunderstanding of the legitimate reasons behind why U.S. health care has been slow to adopt these systems.

The electronic health record concept has been around for a very long time, but the adoption rate in the U.S. is 1.5 percent, according to The New England Journal of Medicine.

The failure of these systems to catch on is not uniquely American.

The British government initiated a 10-year, multibillion-dollar project to implement a national patient record system in 2002.

The British House of Commons published a report in September 2007 and described in painful detail the data collection challenges, budget and schedule overruns.

The irony is despite the single-payer system in Britain, which should make electronic patient records easier to achieve, the British government is learning the hard way that it might be mission impossible.

In comparison, Americans receive health care through 500,000 office-based physicians, 5,000 community hospitals, 16,000 nursing facilities and hundreds of insurance companies, with a full spectrum of ownership, pricing systems and data formats, including paper-based information.

The health care market fragmentation in America creates a formidable challenge compared to the British system.

The electronic health record concept is easy to describe, but the difficulty in achieving such a system is enormous because it is fundamentally not a technical problem.

Under the current rules and regulations, medical records belong to the patient.

But each individual patient’s information resides in dozens of different places, such as the family practitioner’s office, the lab, the hospital, the drugstore and so on.

To create a system of electronic patient records, an individual must have the will to track down — and collect — the scattered data from both different sources and in vastly different formats.

The individual then has to have the access, the know-how and time to enter all this data — error-free — in a single system. The bigger challenge is to keep the data up-to-date as new procedures, medications, referrals, etc. are added.

Electronic health records are the wrong prescription for health care automation.

The right medicine is developing the ability to connect different systems seamlessly through a network of interfaces, or an interchange, that will enable the temporary collection of patients’ data at the right time and place.

The interchange solution is established and proven.

In the travel industry for example, a trip can involve data from multiple carriers, hotel chains, car companies and tour operators.

The trip can be sold online, or through millions of travel agencies all over the globe. Passenger records, such as frequent flyer miles, seating, meals, hotel and car-size preferences are maintained, used and updated for years.

The system also accesses providers’ information, such as availability, schedule, special services and promotions to help the travel professionals and travelers make the right decisions.

The amount and complexity of data in the medical field, as well as privacy concerns, makes this information different from the travel industry.

But a model built on creating interoperability between existing systems will provide a robust, easy-to-implement and cheaper solution.

The most interesting outcome of establishing such an interchange is that the patient’s electronic record becomes a product instead of a condition to build the system.

Investing in health care automation is the right idea. Imposing a single approach to solve the information technology problem is always the wrong approach.

Sameh Abdelaziz of Marietta is IT manager for a major global distribution network.