Too much EHR variation holding the industry back

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This week's opinion article in the Wall Street Journal certainly has sparked some debate. There already are more than 100 comments on the article, which run the gamut, some in favor of electronic health records, and some against. Readers complain about privacy concerns and the foolhardy rush to what amounted to experimental technology. They place blame on the government (both sides), greedy vendors, and associations such as HIMSS.

It's really no surprise that the article's authors referenced studies that reveal that EHRs don't save providers money or improve care. EHRs are only as good as the information they contain and how they are used. Different research studies testing different hospitals, methods and training will garner different results.

What I'm surprised about, though, is the lack of discussion on how to deal with the information in the article, although the article provides it: EHRs lack standardization. Without standards, there's no consistency as to EHR hardware, software, or even the definitions of what should be input. This is why can be ineffective and why data sharing can be so difficult.

What's also surprising is that, as the authors note, standardization wasn't required before so many providers invested in these systems. Other industries are required to be standardized. Imagine, for instance, if light bulb bases all were different sizes; they'd no longer be interchangeable. Now apply that same logic to railroad track widths. Or gasoline.

Yes, it's true that EHRs need to meet testing and certification criteria. But there remain hundreds of vendors out there with products that pass regulatory muster. That still doesn't make them easy to use.   

My own personal experience this week gave me newfound respect and empathy for providers experiencing glitches and frustration with their health IT. I just purchased a new computer to replace my aging clunker. But for some reason, my beautiful new wireless keyboard would not allow me to type the "@" symbol.

Was it a lemon keyboard? Would I need to have a new one shipped, or lug the whole system back to the store?

Just as I was contemplating calling customer support, the IT consultant helping me set up the computer thought to check its properties and discovered that the keyboard was set to "United Kingdom" mode, which evidently configures the symbol differently. Problem solved.

But why on earth would a computer being sold in Maryland use "United Kingdom" mode as its default--and if so, why isn't that information shared with purchasers? And even more fundamental, why aren't keyboards more standardized?

That, however, was a relatively easy problem to resolve. I can only imagine how much worse it is for those of you dealing with ongoing glitches and frustrations with your EHR equipment, which is much more complex.

Unfortunately, there will be some who take the Wall Street Journal commentary as validation that EHRs are detrimental to patient care and not worth the cost. That may be a mistake. As the Institute of Medicine (IOM) reported this month, health IT has the potential to save billions of dollars and improve patient care.

The IOM report also acknowledged that EHRs systems needed improvement in integration, infrastructure, and the like, some of the hallmarks of standardization.

There has been some indication that vendor consolidation will achieve the standardization in the EHR industry that these systems need, but that it may not occur until Stage 3 of Meaningful Use.

Can we afford to wait that long? - Marla

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