Cost is main problem in implementing US EHR

“Although the case for adoption of improved health informatics appears quite compelling, significant barriers to its use remain, particularly with regard to the electronic health record,” says William Hersh MD. "These include cost, technical issues, system interoperability, concerns about privacy and confidentiality, and lack of a well-trained clinical informatics workforce.

Hersh cites a recent study by the Center for Information Technology Leadership that found when healthcare providers initially invest in portable electronic records, they only tend to recoup an 11% return with the main financial benefits going to insurers, laboratories and patients. “A variety of approaches have been proposed… such as ‘pay for performance’ schemes that reward data capture (only possibly with use of an EHR)", says Hersh.

Another problem raised by the Center for Information Technology Leadership is the fact that early adopters may only get these returns when the rest of the community takes up use of electronic health records as well; particularly with regards to record interoperability. “There may be significant disadvantages since early adopters are likely to pay the initial costs without receiving the benefits that will accrue only when the rest of the community is taking part," says Hersh.

The claim comes after a report published by PriceWaterhouseCoopers Health Institute Research said that the $100m pledged by Bush for implementation of EHR “is a teaspoon of the funding needed to digitize a $1.6 trillion industry.” According to a report in Health Data Management, the study’s authors conclude that if Bush “pursues aggressive implementation of electronic records, he will have to find funding to make this possible."

As well as funding, other problems with EHR implementation in the US include confidentiality, as in the UK. Although the implementation of EHR doesn’t make the issue any more important, says Hersh, safeguards still need to still be in place. Nevertheless, “perfect security will never be achieved because human curiosity will derail even the best security methods."

The existence of ‘healthcare data silos’ is also an issue, Hersh contends; data is trapped in individual hospital and physician records and cannot be transported if it needs to go elsewhere.

Herse believes, nevertheless, that these disadvantages can and should be overcome: “Health care IT is not a panacea for all that ails medicine, but it has the potential to improve the quality of care as well as the personal experience for patients."

“It is no exaggeration to declare that the years ahead portend the ‘decande of health information technology’".

Journal of the American Medical Association (subscription needed)