For 20-odd years, the many problems with electronic health records (EHRs) ably highlighted by Karen Guglielmo have stymied the pervasive use of IT in healthcare. But the Feds’ newfound interest in EHR could well change all that. The reason is not so much the $34 billion allocated by the government for electronic health record development – much of that seems destined to help individual doctors or small practices and clinics. For hospitals and other health institutions, the payoff may well be the new air of seriousness surrounding EHR. With the Feds looking for major cost savings to help offset historic deficits, I expect a certain amount of arm twisting to get all the parties to play nice.
We recently surveyed several hundred IT managers in healthcare institutions to see where people are at. Sixty percent have some form of EHR under way, with 36% either planning or in some stage of deployment. IT managers at these healthcare organizations see themselves overwhelmingly as playing a major role in EHR implementation, often leading the project.
The EHR troika is shaping up to be IT, medical records and medical staff. Pencil in the compliance officer and make that a quartet. CIOs I have spoken with are talking up the idea of a chief medical information officer (CMIO), most likely a doctor with an IT bent, as the ultimate application owner. The CMIO is shaping up as the person who can hold software vendors accountable for the two main issues that have plagued EHR to date and that Guglielmo wrote of in her blog entry: unwieldy user interfaces and lack of interoperability.
Within IT, CIOs and security managers will have the biggest involvement in the up-front planning and decision making around which packages to buy, etc. Development staff will, of course, be involved in the inevitable customizations. However, 75% of our respondents will bring in outside professional services for some phase of the project, especially for customization and deployment.
Once established, EHR will become the responsibility of application managers (CMIO or not) and of course, the usual infrastructure directors of servers, storage, database and networks.
Hospitals have often lagged behind corporate IT in their adoption of new technology, with notable exceptions in digital imaging and wireless networking. Still, we are likely facing a wholesale modernization of hospital IT to accomplish the broad goals of electronically managed healthcare. Without high-density commodity servers and server virtualization, for example, it’s hard to see how hospitals can afford to run all this new software. Will they also say goodbye to Unix and rely on Windows and Linux exclusively? Will hospitals be able to afford maintenance of fat clients in every exam room, or will they opt for desktop virtualization of some flavor? Time will tell.
The other thing time will tell is if the government or industry can rationalize the cuckoo economics of EHR. Conventional wisdom is that payers will be the biggest beneficiaries of cost savings, while providers the biggest spenders. Seems like we’re just trading one series of problems in healthcare financing for another unless that’s addressed.