It’s relatively easy to implement something if you’re Belgium…not so much if you’re China. At least, that seems to be the case when launching any sort of new state-wide system: especially to replace anything that’s been running for decades or more.
In the case of efforts to adopt electronic health records (or EHRs), U.S. states, hospitals, and individuals have made progress in the last decade, but not as quickly as some other countries, whether those countries are similarly large with similarly-entrenched health records systems, or not.
A hard sell…
A 2008 survey of 4,484 physicians, published in the New England Journal of Medicine, found that less than 20% of those doctors used any sort of electronic health records.
(Of the +80% who didn’t use electronic health records, 16% had purchased but not implemented an electronic health record system.)
Additionally, a study by the New York-based Commonwealth Fund found that growth in use of EHRs in the U.S. is well behind other developed countries and that – at current rates of adoption – it will take at least 30 years to get such clinical support tools in use with the majority of the doctors in America.
Who’s it working for?
While no country (big or small) has 100% EHR implementation, a few are very close, and some are finding innovative new ways to get past the hurtles of early adoption, lost productivity for training, software flexibility (or lack thereof) and other roadblocks to integrating millions of pieces of paper into one database.
Here’s a look at eight countries who have made progress, some insight into how they did it, and where to find out more on how it all came together:
Trials of Australia’s Shared Electronic Health Record system started back in 2004, working-out the many bugs that came up in real-world testing (the company that initially developed the system went under before the second phase.) This ironing-out phase later included pilot projects in Brisbane South and a surgical patient information sharing trials at local hospitals. In 2005, trials were conducted in Tasmania, as well as across the Northern Territory.
In 2007, a second phase of trials with a greatly-improved system began, followed by accelerated rollouts and upgrades in 2009 and 2010.
Particularly notable was the ability of the electronic system to achieve an estimated 90% uptake of residents from participating remote indigenous communities.
In Western Canada, Alberta Netcare is the province’s public Electronic Health Record system. Netcare allows authorized physicians across the province to view medical records. In turn, the government of Alberta is getting ready to offer the province’s 4 million residents access to their own electronic health records, according to the Canadian Medical Association Journal.
Meanwhile, in Ontario, and after a start-up plagued by delays and a financial scandal, eHealth Ontario is rolling-out electronic health record systems for regional communities such as tech-hub Kitchener/Waterloo as part of the goal of having electronic health records for all Ontarians by 2015. “There’s really no comparison to the way we used to do things,” Kitchener physician Mel Cescon told apple.com (His clinic now uses a handful of Macs to work with records for 12,000 patients that used to take up several tons of file cabinets.) “The system is so much more efficient. It lets us be better doctors.”
In 2008, Estonia became the first country in the world to implement a nationwide “birth-to-death” electronic health record system for nearly every citizen.
Denmark has a centralized electronic database of its citizens’ medical records going back as far as 1977 for basic records and back as far as 2000 for detailed histories.
Approximately 98% of primary care physicians have access to the system, including all hospital physicians and all pharmacists. Time Magazine calls the system “a lesson for the U.S.”
First strategized in 1996 to create a state-wide electronic health record system that centres on secure access to information for patients and meaningful access to high-quality health information for both doctors and patients, such information is now readily available to Finnish healthcare professionals and their patients.
The key to success in the Finnish example was a lengthy, well-considered plan, followed by swift conversion to bills (2006) that were passed into law (2007) with few-to-no bumps along the way.
As a result, all planned e-health services for the country were online by 2010.
2011 legislation now makes it mandatory for all healthcare professionals to use the system.
High-quality IT infrastructure and no-argument legal enforcement has resulted in a fully functioning e-health system from which medical professionals and patients actually benefit.
Another example of where a carefully-crafted “let’s just get it done” approach has worked without offending or infringing on civil liberties, the Dutch minister for youth in 2009 successfully advocated for mandatory electronic health records added to existing data, for information on all children in the Netherlands (including information on each child’s family.)
Success here came in a three-step process that involved digitizing existing health records for all children in the country, data transfer, and, later, a feasibility study to understand the information exchange chain in children’s health care in the Netherlands.
After just one year spent developing the legal context, patient consent and IT infrastructure, the nationwide system has been rolled-out into a test-bed province of more than 300,000 people.
To do so, the country enlisted Helsinki, Finland-based Tieto for the development, implementation and hosting of the system, and Cambridge, Massachusetts-based InterSystems’ HealthShare as the health information exchange software program.
United Arab Emirates
While it hasn’t implemented electronic health records across the UAE, Abu Dhabi is leading the way in using national electronic health record information as a “live longitudinal cohort” in the assessment of cardiovascular disease risk.
None of the above examples are perfect ones – in-fact, we could have called this blog posting “8 countries doing electronic medical records righter” (if we failed English and Grammar, that is.)
And there are many great efforts left off this list (New Zealand, for example, was full-steam-ahead on a regional electronic health record pilot until the federal government pulled the plug on funding to reboot such efforts on a national level. And while the UK is still getting there when it comes to electronic health records, it’s vastly ahead of such countries as Canada when it comes to electronic medical records at individual clinics and hospitals.)
Hopefully, though, the above is some food for thought and a jumping-off point for useful conversations.
Do you know of some local examples where electronic health records are becoming a reality in the U.S. or abroad? Do you disagree that all records have to be electronic? Do you have a personal story of how digital health records have changed your life?
Drop us a line in the Comments area below…
More on electronic Health Record implementation and challenges
Electronic Medical Records (i.e. digital records for individual institutions)