Electronic Health Record Systems: What are They, Why have They Failed for so Long, and What Progress is Being Made Now? C. Peter Waegemann CEO, Medical Records Institute (MRI) Chairman and Acting Director, Centre for the Advancement of Electronic Health Records (CAEHR) Chair, Standards Committee ASTM E31 on Healthcare Informatics Chair, US TAG to ISO TC 215 on Health Informatics Chair, ISO TC 215 Task Force on Consumer Interests Vice Chair, Mobile Healthcare Alliance (MoHCA)

Seven Key Issues in Health Informatics 1.Practitioners Can No More Rely on Memory Alone – Provide Access to Knowledge Bases 2.Health Information To Be Shared Among Authorized Persons 3.Continuity of Care –Patient Information Should be Available to Any Authorized Healthcare Professional 4.Patient Safety 5.Leveraged Skill and Knowledge 6.Changing Provider/Patient Relationship 7.Efficiency (Clinical, Financial, Administrative) EHR Systems Should Provide Solutions to All Six Issues

History of Computer-based Patient Record Systems 1960sFirst Attempts 70s and 80sProgress slowed 1991IOM Study 95-98Failures and Decline of Interest 1999Focus on Personal Web-based Records 2002-Back to the Top of the List

How have vendors and users built upon this vision? They have created: Clinical Data Repositories Clinical Work Stations Clinician Order Entry and Results Reporting Applications Clinical Decision Support Clinical Data Warehouses Master Person Indices Other Systems

Lots of Pressure to Create it EHR Many Organizations Working Are Making it Priority Standards Organizations HIMSS CHI ISO TC 215 EHI IHE HL7 AMIA Various Countries No Consensus on Definitions No Common Vision Uncertainty About Benefits to Practitioners and Providers Complete Lack of Standards What is Success? Order Entry HIPAA – Control over Systems Reduction of Medical Errors Mobile Health Care Charge Capture Applications

What Has Changed? ROI for Components Focus on Doable Applications –Continuity of Care: Interoperability Inside and Outside the Provider –Movement on Architecture Issues –Movement on Terminology Issues Outside Pressure: Patient Safety, Inefficiencies, Patients, Etc.

Where is the Roadmap? Lack of consensus on 1.A Definition that works for all domains and concepts 2.Functions 3.Necessary Building Blocks 4.Essential Functional Requirements

What is an Electronic Health Record? CPR - Computer-based Patient Record CMR – Computerized Medical Record PMRI – Patient Medical Record Information ICRS – Integrated Care Record Services PCR – Patient-carried (Card-based) Patient Record PHR – Personal Health Record EMR – Electronic Medical Record DMR – Digital Medical Record EPR – Electronic Patient Record EHR – Electronic Health Record

Why Has There Been So Little Success?

Federal Government 1.No Mandate at this time 2.VA shows that costs come down with IT Systems: Incentives 3.Consideration of Encouragement Depending on Consensus of Fair Criteria 4.AHRQ – Funding 5.Medicare Bill: e-Prescribing by 2006/7

Understanding Principles National Patient ID Ownership/Guardianship/Stewardship Compatibility/Interoperability Continuity of Care

Hospitals Clinics Physician Offices Long-term Care Facilities Home Healthcare Medical Research Public Health Health Planning Patients/Consumers Central Database Centralized System (CPR Model) – Depending on a National Patient Identifier Central Infrastructure that Allows Integration (Terminology, Architecture, Technical/Systems Interoperability)

Current US Approach Hospitals ClinicsPhysician Offices Long-term Care Facilities Home Healthcare Patients/Consumers CCR Confederated System: Every Provider has a Patient Database Only Relevant Care Data are Exchanged

Organizations Pushing For IT American Academy of Family Practitioners American Academy of Pediatrics Other Medical Specialty Associations Payers American Health Care Association State Legislatures: 21 States

What Can be Expected? Near Term: 2004/ Hospital Field – Complex Improvements of Components 2.Ambulatory Care -Major Change Expected 3.Long-term Care - Major Change Expected 4.Home Health CareIntegration? 5.Personal HealthBeginning But Education RecordNeeded

Copies of these slides may be obtained by ing TEPR 2004 May Fort Lauderdale, Florida Survey on Electronic Health Record Usage and Trends