Electronic medical records: The right medicine for an ailing healthcare system
Published: November 22, 2005
What's ailing the U.S. healthcare system?
It's not lack of funding, that's for sure. In 2003, U.S. healthcare spending was an astonishing $1.68 trillion US, or 15.3 percent of the nation's gross domestic product (GDP). That's twice as much per capita as Sweden, the Netherlands, and the United Kingdom.
Yet these three countries and many others spending a fraction of what we do on healthcare achieve better health outcomes overall for their populations than we do in the United States.1
What else do they have in common? For one, they are modernizing the management of medical information and automating their work flows at a much faster pace than we are2. This is particularly evidenced by their adoption and implementation of electronic medical records (EMRs). Healthcare workers in these countries recognize that contemporary information technology solutions such as EMRs can significantly improve worker satisfaction and the efficiency, safety, and quality of care they deliver.
In contrast, just 17 percent of U.S. physicians are currently using EMRs when caring for our patients. This lack of standardized health information might be a natural result of our more distributed and largely private system for delivering medical services in comparison with other countries. Nonetheless, lack of standardization is impeding our efforts to drive down the cost of healthcare while reducing costly and preventable medical errors.
Political mandate: Electronic medical records for all Americans
Responding in part to our reluctance to embrace technology supported process improvements, President Bush proclaimed in the 2004 State of the Union address that all Americans will have an electronic medical record within 10 years. The administration has also appointed David Brailer, M.D., Ph.D., to lead a federal government initiative called the National Health Information Network. The purpose of this initiative is to create an interoperable national system for the secure exchange of healthcare information. Among other responsibilities, the initiative promotes EMR adoption by all physicians in America.
Making patient information accessible and usable at the point of care, wherever and whenever it is needed, is the foundation for improving efficiency and quality in service delivery. And it is no small endeavor to achieve. Introducing EMR and other information technologies into today's largely paper-based offices can change current work flows, require substantial training, and necessitate a considerable investment of time and capital from institutions already straining to keep up with demand.
Benefits of electronic medical records
How can this investment pay off for us (the healthcare providers), for our patients, and for our nation? I believe there are four very powerful benefits of implementing electronic medical records.
| • | Improved patient care With EMRs, there is less potential for medical errors as well as improved quality and safety in patient care. There is no substitute for having accurate information about a patient's condition and medical history immediately accessible in the office, the clinic, at the patient's bedside, and even instantly in the operating room. |
| • | Accessible patient data—anywhere Critical patient information becomes as mobile as our patients are with EMRs. Up-to-date medical information is accessible even when people move to a new town, travel for work or vacation, or seek medical treatment from specialists in another corner of the country. |
| • | More time with patients Physicians and nurses have more time to spend with patients. EMRs create more time for the work we are trained to do. Currently, as healthcare professionals, we spend as much time performing administrative tasks as we do caring for our patients. We waste entirely too much of our valuable time searching for, waiting for, and correcting information—all common symptoms of a paper-based system. While there is an initial cost in learning and changing to an automated system, the long term benefits should include more time and better information to diagnose and treat our patients. |
| • | Improved patient communications and collaboration Access to patient information in electronic systems has tremendous potential to improve communications and collaboration between patients and their healthcare providers. Giving patients more secure, confidential access to their own medical records and pertinent information about their condition and health characteristics can facilitate more informed healthcare decisions. When electronic medical records are made available to patients through a secure portal, as some healthcare organizations are doing, individuals become empowered to maintain and manage their health more effectively and to comply more easily with treatment plans. |
A well planned, carefully executed strategy for electronic medical records can make healthcare service delivery more satisfying and efficient, improving our working relationships with one another and with our patients. For this strategy to be successful, however, two essential principles must be met: Data integration and data security.
A Microsoft platform for data integration
A system of shared electronic medical records requires integrating information across different systems within an organization as well as across multiple organizations. Today, the average hospital runs more than 200 different computer application systems, most of which are unable to communicate with one another. Individual applications for billing, laboratory work, radiology, and patient charting most often don't work together within one hospital much less with systems in other healthcare organizations.
But there is a way to fix this without requiring that everyone run the same software. Interoperability standards help to ensure that IT systems within and outside a hospital or clinic can communicate with one another and more securely share information. And portal-based solutions can integrate medical information from multiple sources and present that information in a consistent way to facilitate analysis and collaboration.
Microsoft is playing a major role in providing a platform for the integration of healthcare information. The Microsoft .NET Framework is built on standards (such as XML and Web services) to enable increased connectivity across the healthcare landscape. Industry specific standards such as Health Level 7 (HL7) and the Health Insurance Portability and Accountability Act (HIPAA) are supported through extensions to the base platform provided by both Microsoft and its partners. By making it easier to integrate data residing in multiple disparate systems, both within and across organizations, the Microsoft platform enables a consistent and intuitive user experience for clinicians. Furthermore, Microsoft is a proponent of establishing open (or nonproprietary) standards as a means of placing interoperable and seamless solutions in the hands of clinicians and providers throughout the industry. For this reason, Microsoft is heavily involved with healthcare standards development organizations such as HL7 and ASTM International.
Microsoft is also taking the lead in delivering personal health information through integration portals. Portals help distill complex information from disparate clinical systems so that healthcare professionals have a comprehensive view of patient information. Using a single, more intuitive interface, clinicians can easily access this information to provide higher quality care to patients. With the Microsoft Web services architecture, even non-technical users can customize screens and render medical information according to their individual preferences and needs.
The University of Pittsburgh Medical Center (UPMC), for example, developed a portal strategy to bring together information from two disparate electronic medical records systems and dozens of other applications. Implementing a collaborative approach to disease management, UPMC is improving the way doctors and patients communicate and manage care. Using the UPMC portal, patients can view parts of their own medical record, go online and book appointments, order prescription refills, and send health information such as blood glucose level reports. The UPMC portal, which features the latest in security technology, enables real collaboration between physicians and the patients they care for3.
The commitment to patient privacy
As patient medical records become more integrated and accessible, our ability to protect the security of that information and the privacy of our patients becomes an increasingly urgent requirement.
In the information age, many of us tend to associate security risks with electronic data systems, yet paper medical records are notoriously difficult to keep private and to secure. Such patient information can easily be left unattended or inadvertently misplaced. There is no practical way to keep a piece of paper from being photocopied, and there is little more than locked doors and filing cabinets to keep it safe. Much depends on harried, overworked staff trying to remember to follow every step of every procedure, every hour of every day.
Contemporary information technology systems have the potential to provide a far more secure environment to protect patient information.
Microsoft recognizes the imperative to protect patient privacy and actively participates in security-related efforts throughout the technology industry. Microsoft security experts are working within the healthcare industry as well as with experts in law enforcement, government, academia, and the private sector to develop and promulgate best practices for information privacy.
In developing its own software, Microsoft has prioritized the deployment of technologies that help to protect customers and their information, offering automated security measures to prevent misuse and unauthorized access. For example, Microsoft Windows Rights Management Services (RMS) is a new policy-enforcement technology that enables users to protect information at the file level from unauthorized access and use. Among other features, RMS helps prevent records from being copied, forwarded, or printed by anyone who does not have explicit permission to do so. This kind of file-level protection is always enforced, regardless of where the file goes.
Improvements in healthcare economics and quality
The potential benefits of electronic medical records are enormous to us, to our patients, and, ultimately, to the economics of healthcare throughout the United States. The secure exchange of patient information can improve the quality and safety of patient care while lowering the cost of care delivery. But the potential costs are also large, demanding both commitment of resources and careful selection of an integrated, fully functional set of solutions.
Microsoft is helping by building the foundation for more streamlined, efficient, and intuitive information sharing and by working with industry leaders in healthcare and technology to help ensure the safety and security of that information.
Now you and I, the working healthcare professionals on whose shoulders the success or failure of this bold initiative ultimately rests, must step up to the challenge.
It is up to each of us to engage as advocates for the sensible and practical adoption of electronic medical records in our clinical practices. Without our expertise and our commitment, rigid mandates and unworkable solutions may be imposed upon us. Let's use our knowledge, our skills, and our energies to guide the deployment of the very best solutions for our practices and our patients.
Dr. Bill Crounse, M.D., is the worldwide health director for the Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. |
