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What's Plaguing E-health?

Cultural and cost issues continue to impede adoption of electronic medical records systems, but new approaches may provide relief.

By Thomas Hoffman
March 26, 2007 12:00 PM ET

Computerworld - The new electronic medical records system at Harbin Clinic has the strong support of its CEO, board of directors and chief medical officer. Its technology can improve patient outcomes while saving physicians money. But cultural issues, including resistance from some of Harbin’s physicians, have stretched the implementation from two and a half years to four.

Welcome to the world of EMR, where the best technology and the best intentions come smack up against the inertia of human nature.

Advocates of EMR contend that melding these systems with the work processes of physicians, nurses and administrators can dramatically improve the quality of patient care and cut waste out of health care costs. For instance, by using an EMR system, a doctor can view a patient’s entire medical history, use a rules-based engine to pinpoint potentially harmful drug interactions and receive suggestions for new tests and medications.

Studies have shown that the use of EMR systems can help reduce medical errors, including misdiagnoses and unintentionally harmful prescriptions, leading to fewer accidental patient deaths.

But to date, EMR adoption has been a big challenge in the health care industry. Rome, Ga.-based Harbin Clinic is a case in point. Georgia’s largest privately owned, multispecialty medical clinic has 135 physicians spread out across 20 locations in northwest Georgia and northeast Alabama. With 33 different medical specialties under its roof, ranging from endocrinology to ophthalmology, Harbin has had a tough time getting various specialists to adapt their work processes to accommodate the EMR system from Chicago-based Allscripts LLC that it’s installing. Indeed, the cultural and work process differences among these specialists has made the EMR implementation “more difficult than I would have imagined,” says Harbin CIO Tom Fricks.

However, primary care physicians at the clinic immediately embraced the EMR system, since they found it easier and cheaper to key in patient information than to pay a third party to transcribe dictation, says Fricks. But high-end specialists, such as cardiologists, have been considerably more resistant to learning and using the Allscripts TouchWorks EMR system, says Fricks. Cardiologists “don’t want aggravation in their lives,” he explains.

Despite strong support of the EMR system from Harbin’s CEO, the board of directors and its chief medical officer (who happens to be a cardiologist), the project has dragged on.

“It’s been a long process for us,” says Fricks of the estimated $2.5 million to $3 million effort, which Harbin expects to complete in June.

The clinic’s difficulty implementing EMR is not unusual. According to a study released last July by the National Center for Health Statistics in Hyattsville, Md., just 9.3% of all physicians in the U.S. use complete EMR systems. “It’s a field strewn with the carcasses of broken promises,” says Mark Frisse, professor of biomedical informatics at Vanderbilt University in Nashville.



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