The Failure Of The British Electronic Medical Record

Stanley Feld M.D.,FACP,MACE

 The development and use of an electronic medical record is extremely important for communication, rapid diagnosis and clinical decision making, increasing efficiency in working up patients, decreasing the cost of duplication of testing and time delays in medical care and treatment.

 There are many other advantages of using a functional electronic medical records. A person could be anywhere in the world and have his medical information immediately available. The results of all testing should immediately be communicated to the treating physician. All imaging studies should be digital.

Patients’ physicians could immediately read and use them for their clinical decision making.

These are only a few of the advantages of the electronic medical record.  During an office visit the physicians’ cost of removing a chart from the shelf, dictating a notes and pasting lab results into the chart is $7.75. Instant automatic noes and laboratory testing delivered to the chart by electronic medical record cost nothing.

Dr. Don Berwick the head of CMS loves the English system. England has a  a single party payer system of socialized medicine. The healthcare system is controlled by the taxpayer-funded National Health Service (NHS). The NHS committed itself to installing a fully functional electronic medical record in 2002 with the goal to have it completed by 2005. 

“Not one of England’s 250 hospitals has a full electronic records system in 2011. A rollout promised for 2005 will not now be complete by 2015.”

It is easy for government to visualize the value of a fully functioning EMR. The execution of the EMR has proven to be nearly impossible even in Britain’s homogenized healthcare system.

“Of the original big four suppliers, only BT, which is responsible for London and a few hospitals in the south, would remain.” 

 

 “Richard Bacon, a Conser­vative member of the Commons public accounts committee, told Mr. Cameron that the programme, which is years behind schedule, would “never deliver its early promise” of a record for all 50m patients in ­England.”

Of the £11.4bn budget, some £4.7bn is still unspent, he said, and, rather than “squander” it, a better way had to be found to spend it.

Only 44 of 250 big hospitals have received a partially functioning new electronic medical record system after trying for 8 years.  While the installed systems have contributed some functionality they are not fully functional. They cannot fully exchange information.

“The US-owned Computer Sciences Corporation – which is responsible for installing the system in two-thirds of the country but, by a mile, holds the programme’s record for missed deadlines.”

 The installations of EMRs have frequently led to initial chaos in hospitals. There are reports of lost patients, lost records, an inability of hospitals to be paid for the care they provide.

The scope of the program for developing a functioning EMR has been decreased as a result of cost overruns and missed deadlines.  New EMRs for ambulance services and doctors offices have been eliminated.

 In April 2010, the minister then in charge – Labour’s Mike O’Brien – admitted that it would never now   deliver the promised comprehensive solution

Nowhere in the world has found the creation of an electronic patient record easy. Denmark, which has a publicly funded health system, is reckoned by many to be as far ahead as anyone. But even that small country after 20 years still has hospitals that use paper records.

There have been many unintended consequences, too numerous to list, in trying to implement the NHS’s goal for a functional EMR. The NHS has accomplished a few of its goals.

1. The NHS was the first in the world to replace X-ray film with digital images for scans and X-rays.

     2. Half the country’s general practitioners, or family doctors, can now transfer at least some of              their records electronically to another practice when patients move.

     3.Electronic transfer of prescriptions to pharmacies is finally proceeding at pace.

     4. Six million out of 50 million patients now have a summary care record. It contains a limited list of         allergies and current medications. It makes emergency room care significantly safer.  

The NHS has a long way to go and lots more money to spend if they continue the present course.

What is the solution?

1. Create incentives for patients to obtain their clinical information. Scan the clinical information into a thumb flash drive and carry the data on a key chain.
2. Create incentives for hospitals and doctors to open the thumb flash drives and use the data.

This would be an instant solution to a difficult problem. The system would reduce the cost of retesting.

EMR are too expensive for U.S. physicians. Physicians are experiencing reimbursement cuts. A fully functioning system costs more than $60,000 per physician. There are additional costs such as service and upgrade fees.

If a satisfactory EMR was available the government should buy it. They should put it in the Internet cloud. Upgrades should be installed as necessary. A single integrated healthcare system wide EMR would result. Physicians should be given incentives to use the EMR. They would be charged by the click. The cloud EMR must be integrated into a physicians’ present non functional legacy systems.  

This process was used while converting to electronic billing in the 1980’s. It should be done with the EMR now. It will save everyone time and money and increase the ability to diagnose and treat patients rapidly.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.