British EHR fiasco shows U.S. may be on the right track


Is it possible that the Obama Administration is doing something right in its ambitious health IT program? The U.K. National Health Service's failed, decade-long effort to implement a nationwide electronic health record system suggests that, in many ways, the U.S. government is taking a wiser approach to encouraging widespread EHR adoption. On the other hand, it is still possible that the federal government might overreach and hit the same brick wall that the Brits did.

In a recent New York Times piece, reporter Steve Lohr asked three top experts--Dr. David Brailer, Dr. David Blumenthal (both former national health IT coordinators) and Richard Alvarez, who heads Canada's health IT effort--what lessons they drew from the NHS fiasco.

Brailer and Blumenthal stressed the importance of having physicians involved in health IT planning; Brailer went so far as to say that physician resistance to the U.K. National Programme for IT (NPfIT) had "brought [the NHS] to their knees." All three pointed out that a top-down program of this scope cannot work because health IT must be implemented at the local level--which is also the message of the NHS press release about the dismantling of its IT program.

"A modernised NHS needs information systems that are driven by what patients and clinicians want," Sir David Nicholson, chief executive of the NHS said. "The NPfIT has provided us with a foundation but we now need to move on if we are going to achieve the efficiency and effectiveness required in today's health service. Restoring local control over decision-making and enabling greater choice for NHS organisations is key as we continue to use the secure exchange of information to drive up quality and safety."

Perhaps with the U.K. example in mind, the Obama Administration has avoided boxing physicians in with too few choices. In its Meaningful Use and EHR certification regulations, the government has taken pains to ensure that its EHR incentive program would not give an unfair advantage to bigger vendors at the expense of smaller ones. As a result, American physicians have a very wide choice of EHRs and EHR modules that are certified for Meaningful Use--nearly 900 products at latest count. If anything, some observers say, doctors and hospitals have too many applications to choose among--and many of them are unusable.

As I pointed out in this space a few weeks ago, the Administration also has shown a strong interest in working with the private sector to solve problems, rather than imposing solutions from above. For example, the Office of the National Coordinator for Health IT (ONC) has enlisted help from private-sector experts in building the CONNECT gateway to the National Health Information Network, designing the Direct Project secure messaging protocol, and testing metadata standards. ONC also is providing funds to 17 Beacon communities to find innovative ways of using health IT, and is sponsoring cash-prize contests designed to do the same thing.

But the Meaningful Use program itself is a top-down government initiative. While some physicians and consumer representatives are included on the Health IT Policy Committee (which advises ONC on the Meaningful Use requirements), the committee members seem less concerned about the difficulty of meeting the criteria than on whether they move the healthcare quality and efficiency agenda forward.

Judging by conversations I've had with some doctors, I don't believe that the Stage 1 criteria for Meaningful Use contain any obstacles that most physicians cannot surmount if they have a decent EHR and learn how to use it properly. Hospitals will have to work harder, especially in the areas of computerized physician order entry and quality reporting. But many hospitals also will qualify for Meaningful Use either this year or next.

The real challenge is going to be Stage 2. This is where ONC and other government agencies should start thinking hard about how far and fast they want the healthcare industry to go. If there are lots of laggards in Stage 1, maybe Stage 2 should be designed to push providers forward a little, but not too much. When all is said and done, the industry-wide transition to a transformative level of health IT is going to take a decade. And if people are pushed too hard, they must just push back. - Ken (@FierceHealthIT)

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