Status of a US National EHR

• US trails many other countries • US EHR IT spending < other industries• Impact on overall costs is unclear• EHR will improve health outcomes• Benefits ultimately outweigh the costs • ETA remains indeterminate

EHR vs. EMR

• EMR = application that shares patient information within one health care entity

• EHR = allows for health records to be shared across multiple establishments

EHR vs. ATM & RAND Study

• ATM: initiated online banking revolution

• EHR: can similarly transform health care

• RAND: EHR will improve quality > reduce costs

EHR History

• Originated in late 1960’s• Pioneers Weed, Barnett, & Warner• VA adapts EHR circa 1970s• IOM interest begins in earnest during 1990s

Objectives of EHR

Primary and Secondary Uses of an Electronic Health Record Primary Uses Secondary Uses

Patient Care Delivery Education

Patient Care Delivery Regulation

Patient Care Delivery Research

Financial & Other Admin Processes Public Health and Homeland Security

Patient Self-Management Policy Support

Dissenting View

• Increase provider reported services• Slow down patient provider interactions• Fail to improve provider to patient ratios• Persistent errors• Spending will not decline• Inconsistent quality

World EHRs

• Australia, Canada, et al have interoperability standards• US does not yet have mandated standards• CCHIT is standardizing EHR functionality• HITSP is developing standards for interoperability• France, Sweden, et al collaborating to exchange EHI• Canadian EHR = many interoperable EHRs

VA EHR & EHR/HIE Workgroup

• VA EHR > 1,000 VA healthcare facilities

• EHR / HIE Interoperability Workgroup: 15 states, 19 EHR vendors, & 18 HIE vendors ~ 50% of the US population

EHR/HIE Interoperability WorkgroupStates EHRs HIEs

California Alere Wellogic Alere Wellogic

Colorado Allscripts ApeniMED

Florida Cerner dbMotion

Georgia Data Strategies GE

Illinois DeFran Systems GSI Health

Kentucky Dr. First Harris

Maryland eClinicalWorks HealthUnity

Michigan eMDs ICA

Missouri Epic InterSystems

New Jersey ePocrates Med3000

New York First Medical Solutions MedAllies

Oregon GE Medicity

Utah Greenway Mirth

Vermont McKesson Misys Open Source Solutions

Virginia MDClick OmniMD

NextGen Optum

Nortec Software Orion

Sage RelayHealth

Siemens

Challenges

• Dearth of funding• Lack of medical staff support• Inefficiency• Difficulty creating a migration plan• Cost

Summary

• US trails other countries • US EHR IT spending < other industries• Unclear if EHR will lower health care spend• Health outcomes will be improved• EHR benefits ultimately outweigh the costs • ETA remains uncertain