Overview of the discussion on Nov. 3:

I’d first like to say that those of you who didn’t show up missed a fascinating and enlightening discussion on the future of health informatics, and in particular, about electronic health records. But, given that I’m such a considerate and hard-working person, I’ve decided to do a quick recap on the essentials for the benefit the other (6.66 billion – 4) people who missed the wonderful event. Now I will rest at night knowing that you won’t self-flagellate with guilt and regret.

Seriously now, I’d like to compare our discussion to an apricot. The core of our discussion (the seed) was EHR, but as useful as it was, the savory parts were really the digressions that enveloped it. We ate the fruit, and now you will get the seed. Enjoy!

EHR:

• Incorporating IT into health care is essential to improving efficiency, quality,
• The production of information has grown much faster than the ability to process and interpret them.
• As of June 2006, about 94% of physician visits in Canada involve paper records (2)
• “Canada Health Infoway’s mandate is to provide a fully interoperable EHR for 50% of Canadians by
  2009. The Health Council of Canada has called for 100% coverage by 2010. Newfoundland
  anticipates a fully functional, province-wide EHR by 2009. The Premier of Alberta has promised an
  EHR for every Albertan by 2008. Based on performance to date, these are enormously ambitious
  and, perhaps, unachievable goals.” (2)
• “The Booz Allen Hamilton study in Canada estimated savings of $6 billion annually with a
  fully developed EHR, which would cost about $1 billion a year for 10 years to implement.” (2)

Elements of EHR:

• Electronic Medical Records (MD/clinic) for patient encounters
• Laboratory data
• E-prescribing with decision support built in
• Diagnostic imaging (PACS)
• Hospital data (ER, inpatient, outpatient)
• Home care
• Long Term Residential Care
• User access to own record

Benefits:

• Promotes teamwork and empowers patients: “Giving patents access to their EHR is the wave of the future. Experience to date in Denmark and the US has been uniformly positive. If the patient is to be at the centre of the system, the patient has to be included in the information network and given the capacity to contribute to and use the EHR, and to communicate with the care team.”
• Improves safety: “Nation-wide implementation of the EHR in the US, including e-prescribing with decision
  support tools built in, could reduce adverse drug events by two million annually, preventing
  190,000 hospitalizations. According to the literature, introducing the EHR into the ICU reduces ICU mortality by
  46% to 68%; complications by 44% to 50%; and overall hospital mortality by 30% to 33%. The use of e-prescribing in Denmark has reduced the medication problem rate from 33% to 14%, and laboratory systems have reduced tube labelling errors from 18% to 2%.” (2)
• Shorter wait times: “Evaluations of telehealth home care and chronic disease management programs have shown
  among users of the services: 34% to 40% fewer emergency room visits, over 32% fewer hospitalizations and up to 60% fewer hospital days, 47% reduction in long term care admissions.” (2)
• Jobs! the Health IT market is to double by 2011, with annual double digit increases (4)

Challenges:

• Many health care workers must undergo new training
• “Moving to an EHR in its fullest form is not just a technical innovation; it is a cultural
  transformation. Change management is vital, and failure to build in processes for effecting
  the transformation will reduce both uptake and impact. In the words of one presenter, all of
  us – providers and managers in particular – need to complete the transition from resistance
  to electronic information (historical position) to acceptance (current position) to addiction
  (can’t function without it).” (2)

Privacy Issues:

• There are concerns that electronic records may be accessed by unauthorized third-parties (i.e. hackers), but these can be addressed by security-enhancing technologies.
• The law protects patients’ privacy: “…Information that can identify individual patients must not be used or disclosed for purposes other than health care without the patient’s explicit consent…. In contrast, anonymized information is not confidential and may be used with relatively few constraints.” (3)
• “If you apply for life or health insurance, the insurance company will often need your medical records before giving you insurance.” (6)

Links:

1. EHR at Health Canada
2. Beyond Good Intentions: Accelerating The Electronic Health Record in Canada
3. Legal and Ethical Aspects of Telemedicine
4. Report: Health IT Market to Double by 2011
5. The new threat to your medical privacy
6. Getting Your Medical Records
7. Wiki: EHR