Despite the investment of tens of billions of Euros in healthcare IT the industry worldwide has failed to deliver on the vision of an integrated computer-based electronic medical record. Instead the industry must now focus on focused web-based electronic health records that deliver immediate benefits to patients and clinicians.

Opening Mobile-Health Europe in Maastricht this week Dr Peter Waegemann, chief of the medical records institute and a passionate advocate of electronic records, said: "We have not gone far enough and have a really major stretch ahead of us."

He pointed out that despite massive investment, thousands of IT and management consultants and the involvement of many healthcare professionals very few healthcare systems yet have a single integrated medical record.

The approach of individual computer-based electronic records which can then be linked together to provide a global picture of the patient has failed to deliver and a new approach is needed. "The computer based patient record, which is inter-operable and accessible by different clinicians is dead, it didn’t happen and won’t happen for a while."

A key reason for the failure to deliver on the vision first set out 13 years ago, said Dr Waegemann, has been the lack of a standard definition of interoperability and common standards.

Other key barriers he identified, included the difficulty of showing return on investment on electronic health records (EHRs), which often only deliver savings further down the road and initially require physicians to actually spend more time entering data onto systems.

The approach that now needs to be taken instead must be based on web-based electronic health records which consist of focused components that deliver real clinical and economic value. "The vision is that every patient’s record is on a secure and safe website that provides information to all authorised persons," said Dr Waegemann.

He told the audience that the challenge was to develop focused systems that will deliver benefits in months rather than years.

In his vision of the future, Dr Waegemann said, "everyone has a complete longitudinal record of every treatment" that would be web-based, secure and easily updated and accessible by all authorised health professionals.

He added that the vital need for effective electronic records was shown by the huge numbers of patients who die from medical errors directly attributable to documentation problems.

“It’s said (by the US Institute of Health) that 7,000 people in the US die each year due to errors from documentation, this is happening year by year and worldwide the total figure is a about 25,000,” said Dr Waegemann, "But we go on as if nothing is happening."

Unless the healthcare industry delivered effective ICT systems that directly support care he warned that consumers would vote with their feet, a trend he said was already underway,"13m people have now put their health records on commercial sites, which they have collated themselves". The danger of this trend he warned was that without common standards such records would be fragmented and of little value to health professionals.

He added that the value of Mobile Health is that it provided the tools to make EHRs viable and enable them to improve clinical decision making by making patient data and documentation available at the point of care.

"We can only succeed with EHR when we have the documentation available in the exam room," said Dr Waegemann.

With 95% of US practitioners now possessing some form of wireless device, be it phone, PDA or handheld he offered the prediction: "The future of e-health is the mobile healthcare computing device".

The challenge he said was to add new functions to such devices to provide a much clearer focus on the patient rather than just on administration. “Mobile healthcare is just beginning and we have no idea where it will take us,” said Dr Waegemann. "Mobile healthcare will change the way medicine will be practiced."