Will be there chaos for e-health roll-out?

Implementing e-health

By 2015, hospitals and physicians in the US have to have deployed comprehensive electronic health records (EHR) and the accompanying technology in order to meet federal guidelines, and qualify for billions of dollars in reimbursements through the American Recovery and Reinvestment Act of 2009. But as the roll-out happens, is the US set for chaos?

Numerous studies have examined the value of health IT in improving patient safety, increasing co-ordination of care and improving quality. However, despite the documented improvements available from health IT, adoption rates remain low. The Robert Wood Johnson Foundation in 2006 estimated that only 17 to 24 percent of office-based physicians use some type of EHR. And a survey, conducted in 2008 by Ashish Jha et al, found that just 1.5 percent of US hospitals had implemented a comprehensive EHR and just an additional 7.6 percent had a basic EHR in place.

Some healthcare experts are concerned that the roll-out of e-health systems might be at risk because of unrealistic deadlines, and confusion on what to implement first.

"I think we have non-technology people making decisions about technology," said Gregg Veltri, CIO at Denver Health, a healthcare group that serves some of Denver's poorest residents, to Computer World.

"The issue is the timelines. I wonder if anybody understands the reality of IT systems and how complex they are, especially when they're integrated together. You're going to sacrifice quality if you increase the speed [of the roll-out]."

Several key pieces still need to fall into place before Medicare and Medicaid, the programs handling the subsidies, will be ready to funnel about $14 billion to $27 billion in net payments into the purchase and meaningful use ofEHRs by hospitals and office-based physicians.

In late December, the federal government released a 556-page draft rule that contains specifications and certification criteria for EHRs. Those rules, now available for public comment, set a four-year goal for implementation and spell out best practices in delivering care and sharing patient information between hospitals and clinicians.

On 12 February, the US Centers for Medicare and Medicaid Services issued a finalized version of its Notice of Proposed Rule Making that help define what type of technology should be used and how $36 billion in incentives from the American Recovery and Reinvestment Act of 2009 should be paid. The money would be distributed between 2011 and 2015.

Implementing EHR's

Last year, just 10 percent of healthcare facilities in the US used EHRs; by 2014, the government wants more than half of all facilities to use them.

Physicians who implement EHR systems can get as much as $44,000 to help with technology costs; a typical 275-bed hospital would be eligible for approximately $6 million. But clinicians andhealthcare facilities must show they're using EHRs in a meaningful way beginning in the government's 2011 fiscal year to qualify for a full incentive payment. Hospitals that don't meet federal guidelines by 2015, will face Medicare reimbursement cuts.

A major disadvantage found of implementing EHR's, is the usage of them by nurses and doctors. It's automatically presumed in this day and age that people go home and use a computer - use theinternet, but that isn't the case.

"We thought everyone browsed the Internet at night and used a BlackBerry, and that a computer mouse wasn't a frightening tool," said Veltri. "What we found out was that nurses don't even answer their emails. Email applications are foreign to them. They're just used to doing everything on paper."

Computer World states that implementing EHR's in hospitals is far more complicated than for doctor's offices, because they aren't all-inclusive bundled systems. Hospitals use piecemeal technology that's rolled out department by department and requires integration. And since many hospitals won't just rip and replace their existing IT infrastructures, they'll be forced to integrate new physician and nurse documentation systems, computerized order-entry systems and relational databases with their existing systems.

Jodie Humphries

Jodie Humphries graduated from Bath Spa University with a BA Hons in Creative Writing in 2008. She has worked for GDS Publishing for the digital group since July 2009. She has previous experience with writing for the web, running her own website since April 2007.

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