More Hurdles Appear in US Electronic Health Record Adoption

There were a couple more of stories about electronic health records (EHR) that caught my eye the past few weeks that serve to highlight some of the real hurdles that need to be jumped before a national EHR system comes into being in the US.

The first was a story from a few months back that I ran across recently from the Washington State Spokesman-Review about Inland Northwest Health Services suing the owner of Deaconess Medical Center, which the paper said alleged breach of "contracts and bad faith dealings that imperil the region's acclaimed electronic medical records network."

It is a bit complicated, but in essence, in 1994, Spokane's Deaconess Medical Center, Providence Holy Family Hospital, Providence Sacred Heart Medical Center & Children's Hospital and Valley Hospital & Medical Center established the non-profit Inland Northwest Health Services (INHS) as a way to merge competing lines of business and to oversee them. One of the things INHS did was to invest in electronic medical records using MEDITECH's technology.

Apparently, Community Health Systems, a Tennessee company that bought Spokane's Deaconess Medical Center and Valley Hospital & Medical Center in 2007 decided that it was going to start charging INHS $150,000 a month to use the MEDITECH license, claiming that Deaconess Medical Center was owner of the license. INHS says that Deaconess transferred ownership to it years ago.

The Spokesman says some 38 hospitals along with many private practices and clinics are affected by the dispute.

The upshot of all this is that license ownership of the underlying EHR technology will likely be a big issue in the future as more regional health information networks are started, as will be technology lock-in (INHS has been using MEDITECH technology for 13-years, and it moving to another EHR is unlikely to be an easy or inexpensive proposition). Neither issue has appeared much in the EHR literature.

Then there was also a story in the American Medical News in late November about the Cleveland Clinic giving $1 million to a start-up company called Explorys to "commercializing the patient database search system Cleveland Clinic developed." The Cleveland Clinic has a very extensive EHR system and data base of patient information that it now wishes to exploit.

As I mentioned last month, there was a report by PricewaterhouseCoopers LLP that found 76% of healthcare executives surveyed felt that all the data being collected in their EHR systems was going to be their organization's greatest asset over the next five years. It also found that the executives only felt they could recoup their investments if they could exploit that information in some way.

Being able to exploit information may be a bit harder than it seems.

According to this study titled, "Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method" by UCL Professor of Primary Health Care Trisha Greenhalgh et al. published in the Milbank Quarterly in November, somewhere between 50% and 80% of electronic health records projects fail. Not surprisingly, the larger the EHR project, the higher rate of failure.

Ms. Greenhalgh was quoted in the Healthcare IT News as saying, "Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of electronic health record projects fail - and the larger the project, the more likely it is to fail....Our results provide no simple solutions to the problem of failed electronic patient records projects, nor do they support an anti-technology policy of returning to paper. Rather, they suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world."

But calls for more less technology-push and more realism about EHR systems tends to fall on deaf ears when there is potentially a boatload of money to be made.

In mid-December, Siemens Healthcare announced its plan to offer a "series of flexible financing solutions  to help healthcare providers pursue meaningful use objectives and meet deadlines defined within the HITECH provision of the American Recovery and Reinvestment Act (ARRA). Featuring zero-percent interest terms for qualified customers, the solutions enable organizations to defer up-front payments associated with their technology investment while meeting criteria for future government incentive monies."

Kind of like offering a subprime mortgage with no money down required; except you can't ever afford to sell the house.

Siemens also didn't say what interest rates it will be charging its not so qualified customers.

What makes this even more interesting is that IBM is helping underwrite Siemens' effort. I suspect IBM, however, is not offering Siemens zero percent interest as part of its financial deal. IBM is however, expecting Siemens to sell (and provide financing for) its hardware and consulting services to Siemens' EHR customers.

And finally, the US Department of Health and Human Services released at the end of December its 556-page proposed "meaningful use" rule (no, it wasn't a typo - it's 556-pages long) that defines what hoops "eligible professionals" and hospitals will have to jump through to become qualified to receive incentive money from the US government towards their investment in an EHR (up to $40,000 for a single doctor).

Early reactions decidedly are mixed.

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