Wednesday, April 15, 2009

Electronic Health Records

At the dawn of 2004, three consecutive State of the Union addresses included a line naming an electronic health record for all Americans as a national goal. The administration established the Office of the National Coordinator for Health Information Technology to promote the adoption of modern information systems in health care nationwide, with particular emphasis on the ability of health care providers to share information electronically. The policy is motivated by the belief that replacing paper health records with electronic records will make health care delivery better, safer, and less-expensive, as digital record-keeping and communication has in other industries.

One historic reason for the underuse of information technology in health care has been that the market for clinical software was dominated by niche vendors with limited money and personnel to invest in software development, at least relative to the major computer and software companies. The last few years have seen dramatic changes in this situation, with several of the largest brand name software companies making forays into health information technology. To help make the choice of software easier, software companies have partnered with national health care organizations and the Department of Health and Human Services to create certifying criteria for clinical software. The Certifying Commission for Health Information Technology (CCHIT ) uses a consensus process to create a set of voluntary, annually updated criteria that software companies can choose to have their products tested against in the hopes of receiving the CCHIT seal of approval.

For clinicians, clinics, and hospitals, the hardest part of implementing an electronic health record is not choosing or installing the right software, it is adapting the way work gets done to the new tools. Many software systems have been installed only to be used incompletely or not at all, because of either an under-appreciation of how difficult it is to adapt clinical work without interruption, or because the necessary expertise was not obtained. For large hospitals and networks of clinics, it is feasible to directly hire clinicians with a background in information technology and information technology professionals with experience in health care to jointly lead a successful clinical software rollout. For smaller practices, consultants can be hired on an as-needed basis, although the expense can still be substantial. The considerable investments in software and specialized expertise required for a small hospital or small practice to implement an electronic health record continues to be one of the most important barriers to wider adoption of modern information systems, and whether this instead should be funded regionally or nationally is a topic of ongoing debate.

For patients, the benefit of doctors or hospitals using an electronic health record is in knowing that your important health information will be available whenever it is needed. Although having a doctor seated at a computer while talking about a your health history might feel awkward or intrusive, studies have shown patients view this positively as long as the physician is skilled at focusing their attention on the patient, and avoiding letting the computer interfere with the quality of the conversation. A shared computer screen in the exam room or at the hospital bedside can facilitate the patient and the physician looking at information together, which can help patients understand their health status, and make sure the information maintained by the clinician is correct.

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