Tag Archives: EHR

EHR Challenges in the Netherlands

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My friend FJ, who blogs at TechSocioTech, sent me a link to a news article from a Dutch newspaper, covering the results of a survey of 1800 patients by the Dutch Patient Consumer Federation. Since my Dutch is poor, he kindly provided me with a quick translation (probably not intended for blog publication, but it’s a lot cleaner than Google translate!). It speaks for itself:

AMSTERDAM – Medical records are often full of errors and incomplete. Almost 60 percent of the people who responded to a campaign to notify the Dutch Patient Consumer Federation (NPCF) had to correct or supply missing information to caregivers because insufficient information was available.
Moreover, participants regularly noted egregious mistakes.Therefore a large majority has a negative attitude towards digital medical records. The case files of one in five patients were even lost at one point or another, a spokesperson said.
Most people who are already worried about the medical data are therefore also skeptical about the safety of the SPD. While they worried, two thirds believe that digital exchange of patient data is helpful in case of emergency,  medication, and clinical insights. 1800 people took part in the campaign of NPCF. (ANP)

I’ve been trying to find an English copy of the press release, but no success so far. Do we have an entire country of ePatient Daves? This reinforces a simple observation about EHRs in general – they probably won’t be widely accepted until the data quality reaches a sufficiently high level, and that just hasn’t happened yet. Right now consumers expect that EHR data is both more widely available than it actually is, and over higher quality. What happens when they find out?

CCHIT and EHRs, again

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John Moore has a good summary of the ongoing debate about CCHIT, its relationship with the HIMSS trade group, and the challenge for “meaningful use.”

In summary (and I completely agree with John) – one outside, independent organization should NOT be the controlling gate for all HIT investment over the next ten years. CCHIT would like to be that organization, and who can blame them? But I’d be worried even if there wasn’t any relationship to a trade group at all.

Fed Sponsored, Open Source EHR

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Senator Jay Rockefeller (D-WV) has introduced legislation calling for universal adoption of Electronic Health Records. The law would create a “public utility” board within the Office of the National Coordinator for Health IT, and the board would be responsible for coordinating the development of an open source EHR solution. There would also be additional funding (presumably over and above current stimulus dollars) for safety-net providers to cover the full cost of implementation and maintenance for a five year period.

That could be a lot of money. I’m working off the press release here, since I can’t find the text of the proposed legislation online – but I could see that being interpreted as paying for a substantial portion of a provider’s IT budget. There’s no question this would drive adoption for Health IT! It’s unclear that the open source condition would really effect the overall cost of the plan, as software licensing fees, while not trivial, are not the largest component of a hospital or small-office Health IT roll-out. If the goal is an EHR roll-out, why not let the provider pay for Epic with its own budget, and then subsidize the implementation costs (since they’re proposing to do that anyway.) But I digress.

My real question is the efficacy of the “public utility board” for shepherding the open source process. The bill calls for facilitating ongoing communication with the open source community to incorporate improvements and innovations into the “core programs.” I could see this going very badly indeed – I’ve been looking for last night hand haven’t come up with any large scale examples of large-scale government engagement with open source. VistA, the VA EHR system that is often exhibit A when talking about government support for open source, is very much accidental software, as the open source release was the result of a Freedom of Information Act request, and the VA has not exactly taken a leading role in facilitating the VistA open source community.

Open source development “managed” by the federal government sounds like a Bad Thing. A federal grant program for creating and maintaining open source healthcare applications, on the other hand, could be a very good idea – if encouraging an open source alternative to commercial EHRs is a seen as a public good, there’s an opportunity to fund companies to build those open source interoperability components, to support CCHIT certification of open source projects, etc. Many of my reservations about CCHIT would be dramatically reduced if they had a financial incentive to certify as many open source applications as possible – or if the certification of “meaningful use” was contingent on the availability of multiple certified open source alternatives.

The Rockefeller Bill is just a proposal, and if history is any guide it’s not going to move forward, at least in its present form. But this is as good a time as any to start thinking about ways the government can, productively, support the development of open source options for physicians.

(For further reading: Fred Trotter’s really excellent NCVHS testimony on open source EHRs.)