Module 6: One new thing

This module taught me about the barriers to creating meaningful electronic health records (EHR). Obviously the technology's there, but there are so many pragmatic hurdles to making EHR useful, i.e., usable. Of course, many of those hurdles are the natural byproduct of a clunky, fragmented health care delivery system. If we were to change the health care delivery system to a single-payor model it would be much easier to reap the promised benefits of EHR. The health care systems that currently use EHR successfully are closed systems that can follow their patient populations over time: the VA, Kaiser's HMOs, or even the big hospitals like the U where we see the same patients over and over for care provided by physicians working within our institution. But when a patient enters our system from another system, that patient typically will be accompanied by a sheaf of copies of paper records and we start our data collection at the beginning with an admission interview that, no doubt, misses a lot because the patient doesn't remember or understand the details of previous conditions and care. Prior to this week's module I didn't really appreciate just how big the challenge is--I mean, I'm on board with the benefit that medical informatics brings to the table, and just like everyone else I look forward to a future where we can leverage information technology to improve health care, but I didn't understand why it's such a currently impossible dream. Mainly, it seems to me that it will never happen unless it's forced on providers with no opt-out provision, and the chances that that will happen in the current political climate are zilch. What we will see is creation of larger small networks--like the one we have at the University Hospital--and the benefit is that we can work out the kinks on these small scales so when the time comes for real change we'll have the nuts and bolts of a better system ready to go.