It can't be said enough: EHRs alone won't fix healthcare. We got some more peer-reviewed ammunition behind this statement with a pair of articles in this week's Journal of the American Medical Association, and the authors even managed to put their arguments in the context of health reform, despite the politicians' seemingly singular focus on the insurance market.
Dr. Leonard W. D'Avolio of the Veterans Affairs Boston Healthcare System makes the case for interoperability by arguing that current EHR systems may actually hinder quality improvement by being "unsuitable for detecting quantifiable trends" since they tend to be tied to a single institution. He calls on HHS to require health IT systems that can share and pool data for the purpose of quality improvement. "Regional networks of databases can be used to pinpoint outbreaks of infections or to highlight differences in care of patients from one hospital to the next," D'Avolio writes.
In the second article, Houston-based medical informaticists Dr. Dean Sitting and Dr. Hardeep Singh propose eight "rights" of safe EHR use that developers must consider: appropriate content, government regulations, hardware and software, monitoring systems, organizational culture, training protocols, user interfaces and workflow coordination. "[C]oncerns have been raised about the safety of EHRs in light of the limitations of currently available software, the inexperience of clinicians and information technologists in implementation and use, and potential adverse outcomes associated with clinician order entry and other clinical applications," they say. "Without high-quality, well-designed and carefully implemented EHRs, highly reliable, safe health care may never be achieved."