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Electronic Health Records Key to Boosting Patient Safety, Communication Between Patients and Clinics

   Portland, Ore.

However, finances for medical informatics must be realigned and health care data and systems must be interoperable, according to an Oregon Health & Science University physician in a recent JAMA opinion

The need for information technology in health care settings has become universally accepted in the last 30 years; however, resources for investment are still limited and not enough data is accessible or workable from one health care setting to the next. That's according to William Hersh, M.D., professor and chairman of medical informatics and clinical epidemiology in the Oregon Health & Science University School of Medicine who was asked to write an opinion in the Nov. 10, 2004, Journal of the American Medical Association (JAMA).

In "Health Care Information Technology: Progress and Barriers," Hersh said that increased emphasis on patient safety and medical error prevention, as well as the development of new biotechnologies, has made the need for medical informatics applications in health care apparent to the larger community. The organization of the National Health Information Infrastructure and the National Institutes of Health Roadmap are two milestones that solidify the importance of information technology in patient care and research, he said. Other important recent developments are a bipartisan consensus on the need for health care information technology as well as the creation of a new Office of the National Health Information Technology Coordinator in the federal government.

But significant barriers to information technology remain in health care settings, Hersh said, particularly with regard to the electronic health record (EHR). Such barriers include cost, technical issues, system interoperability, concerns about privacy and confidentiality, and lack of a well-trained clinician informatics work force to lead the process.

"The biggest impediment to information technology being adopted in health care is financial, which results from the misalignment of costs and benefits," Hersh said.

A recent report suggested that ambulatory EHRs, particularly when used with clinical decision support tools, are a positive investment for the health care system as a whole, Hersh said. But those who are expected to pay for EHR systems -- primarily physicians -- only see 11 percent of the return on investment. The rest of the investment goes to insurers, laboratories and patients -- those who don't typically pay for the electronic health record systems.

"Though several ideas have been proposed so that physicians and those paying for electronic health records see more of their investment, this problem is a significant financial challenge that will need to be overcome, particularly for physician offices that are small or in rural and underserved areas," Hersh said.

Technical issues also pose additional barriers to more widespread adoption of health information technology, Hersh said. For example, implementing an EHR in a clinical setting is much more complicated than connecting a computer to the Internet or installing software from a CD-ROM because electronic health record systems must conform to the workflow of a practice or the workflow must be modified in such a way that the system isn't impeded.

Another challenge is that most health care data, whether on paper or electronic record, are trapped in "silos" so that patients' electronic records aren't accessible from one health care setting to the next. Though the widening of broadband Internet makes interoperability achievable, Hersh said, there are no incentives for individual health plans or physicians to help facilitate interoperability and, in fact, early adopters are likely to pay the initial costs without reaping the benefits.

In this era of health information technology, physicians and health care organizations must be vigilant in instilling a culture that demands patient privacy and confidentiality, Hersh said, though he notes that paper records are at least as insecure as electronic ones, and may actually be less secure.

"Even if the myriad of financial and technical issues surrounding the use of health care information technology are solved, a work force capable of leading its implementation must be developed," Hersh said. "Physician-informatics leaders must guide the effort in concert with others in health care, with appropriate knowledge and skill in informatics to lead efforts in all health care settings."

"Health care information technology 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," Hersh said.

Hersh was recently appointed to serve on a newly formed EHR & Health Data Connectivity Subcommittee, which is part of the Oregon Health Policy Commission, a group that provides advice to the Oregon Legislature. The subcommittee has been tasked with preparing a report for legislators on the current status of EHR usage and health information exchanged in the state.

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