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December 26, 2006
Pick any barrier to interoperable electronic health records (EHRs). Clinician resistance. Cultural issues. Change management. Funding. Software deficiencies. Incompatibility. Privacy and security. Turf battles over data ownership. Think these problems are unique to the disjointed, inefficient U.S. healthcare system? Think again. This became abundantly clear at the first-ever World of Health IT, an event which brought 1,800 people to Geneva, Switzerland, from all over the globe this fall to discuss issues that unite them and share strategies that may be ripe for export. “I would reckon that the most important barrier [to IT adoption] is the cultural one,” said Lluis Pareras, MD, chief of public health for the city of Barcelona, Spain. “The area where we need to invest more money, probably, is in the interface between the data and the physician. We need to design something intelligent that will make the work of physicians easier,” said Pareras, a neurosurgeon at Hospital Valle de Hebron in Barcelona. “Amazing as it may seem, a pad and pen are a great way to collect information,” Pareras added, because they make for quick note-taking. “Time is the most valuable thing that I have,” he said, echoing the sentiments of doctors worldwide. Ideally, an EHR should save time, but it remains an uphill battle to convince physicians to trade in their paper for computers. Likewise, a poorly planned or executed transition may set the cause back even further. “With CPOE [computerized physician order entry], we went from failure to failure,” said Jacques Cinqualbre, MD. While these words conjured memories of the 2003 CPOE debacle at Cedars-Sinai Medical Center in Los Angeles, Cinqualbre was referring to Hôpital Strasbourg in France, where he is head of surgery and EHRs. As Pareras found in Spain, Cinqualbre said physicians and nurses at the French hospital preferred writing out orders and documentation to typing or mouse clicking. It took plenty of trial and error before Cinqualbre brought in tablet PCs and high-tech digital pens with electrostatic paper to capture handwriting, making the technology more accessible for clinicians. Antoine Geissbuhler, medical informatics director and chairman of radiology at Geneva University Hospitals, reached back a century and a half to make a point about listening to clinical staff, quoting Florence Nightingale. “In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison,” the nursing pioneer wrote in 1863. Her words could hardly be more relevant today. “Give physicians information to buy goodwill,” Geissbuhler suggested. “You will need that goodwill when you try provider order entry.” After that, he said, clinical decision support, clinical reminders, and other advanced informatics tools related to CPOE ought to be less difficult for all parties involved. It appears that Europeans are just like Americans when it comes to advocating strategies that have almost become cliche, namely seeking out the “quick wins” and the “low-hanging fruit.” Similar to the many fledgling regional health information organizations in the United States, the European Health Telematics Association (EHTEL) is attacking a single component (e-prescribing) as part of its Interoperability Initiative for a European eHealth Area (i2-Health). i2-Health participants from several countries are recommending “running demonstrators to achieve and prove cross-border interoperability,” following accepted European regulatory processes. “There is very, very clear evidence that this is already saving costs,” said Stephan Schug, MD, EHTEL cofounder and manager of the i2-Health project. At the Geneva conference, EHTEL issued a series of papers calling on IT leaders to engage average citizens in public discourse about e-health policy as a means of increasing IT uptake. It’s not too different from all the talk of consumerism in U.S. healthcare. “Currently, most discussion about the development of e-health systems happens between the developers and national institutions where there is very little interaction between those organizations and the patient,” the preface of one of the documents reads. Additionally, EHTEL cautioned that HIT policy will fall short if “consensus” organizations drawn up to advise European health ministries on issues of personal health and national healthcare priorities do not look beyond patients with chronic illnesses to encompass healthy populations. “To represent the field, you have to be [inclusive of] more than a chronic patient,” said EHTEL Director Angelica Frithiof. A recent survey by the Commonwealth Fund and Harris Interactive that found that 98% of general practitioners in the Netherlands and 89% of those in the United Kingdom were using electronic medical records, compared with only 28% of U.S. primary care physicians, may seem to indicate that Europe is light years ahead of America in terms of HIT. But European officials quickly point out that depth of information is greater in North American hospitals, as is spending on IT for acute care. Although IT represents only 2% of overall healthcare spending in Western Europe today, the European Commission—the regulatory arm of the European Union (EU)—forecasts that this share will rise to 5% as soon as 2010. “Improving ICT [information and communication technologies] infrastructure must become a top priority, and policies must reflect this,” said Baroness Emma Nicholson, a British member of the European Parliament. Leaders should link healthcare with the general technology and telecommunications sectors within each EU country. Another report discussed at the conference was the World Health Organization’s (WHO) newly released collection of country-by-country profiles of e-health capabilities. While there were no surprises in the profiles of highly industrialized nations, the results suggest that access to care is a greater issue than interoperability or even basic IT in some parts of the world. “Given the choice between ICT and access, people are going to choose access every time,” said WHO project manager Joan Dzenowagis. While Dzenowagis witnessed this phenomenon firsthand while touring India, it could equally apply to some of the less-developed central European members of the EU—or to inner-city immigrant communities in the United States and hurricane-ravaged areas of the Gulf Coast. — Neil Versel is a Chicago-based journalist
specializing in HIT. He reported this story from the World of Health
IT conference in Geneva, Switzerland.
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