The Painful Side Effects of Deploying Electronic Health Records

Three healthcare IT experts including a former policymaker, a CIO and a doctor who is also an IT manager, discuss the difficulties of deploying electronic health records.

By Allan Holmes
Mon, January 15, 2007

CIO — According to a recent study by Massachusetts General Hospital and George Washington University, less than 25 percent of all U.S. doctors use some form of electronic health records (EHRs) in their practices. Far fewer—only around 10 percent—have fully operational health information systems that collect patient health data, manage information such as orders for lab tests and prescriptions, and provide decision support.

Meanwhile, many of those healthcare facilities that are deploying EHR systems are having difficulty making the systems work. In November, an internal report by Kaiser Foundation Hospitals that was leaked to the press detailed hundreds of technical problems with the $4 billion enterprisewide EHR system supplied by the vendor Epic Systems. By 2009, the project, called HealthConnect, is supposed to provide doctors access to records for all 8.6 million Kaiser patients. But the system has suffered from excessive downtime, according to the report. In addition, users experienced problems accessing certain applications that allegedly did not scale well to Kaiser’s vast network. Three days after the report became public, Kaiser CIO Cliff Dodd resigned, although the company won’t comment on any connection with the troubled project.

Yet health policy experts say EHRs are what’s needed to reduce the 225,000 deaths a year due to medical errors and adverse effects of mistakenly prescribed drugs, among other ailments of the healthcare system.

From 2004 until last year, David Brailer, a physician and the first national coordinator for health information technology, led a Bush administration initiative to persuade the nation’s 885,000 physicians and the management of approximately 5,000 hospitals to invest millions of dollars in electronic health information systems and connect them to form a national network. Brailer readily acknowledges the challenges of convincing clinicians to change long-standing business processes, of delivering an ROI, and of ensuring interoperability among doctors’ offices and hospitals on a grand scale.

Meanwhile, John Glaser, CIO of Partners Healthcare System, and Hilary Worthen, a physician and senior director of clinical informatics at Cambridge Health Alliance, have labored for years in the trenches to deploy EHR systems. Partners is a network of 7,000 physicians and 10 hospitals, including Mass General, a teaching affiliate of Harvard Medical School. Cambridge Health Alliance includes 25 outpatient centers and three hospitals in the Boston area. The organization records some 600,000 outpatient visits and 20,000 hospital discharges a year. Most of its patients are low income or face language and cultural barriers to accessing health care.

CIO brought Brailer, Glaser and Worthen together in a conference call and via e-mail during October to trade their insights about managing the transition to EHRs successfully.

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