Electronic Health Records at a Third of the Price

Despite campaign rhetoric from nearly every presidential candidate in ’08 and the creation of the National Health Information Technology Coordinator by President Bush over five years ago, our nationwide adoption of electronic health records in hospitals, basically, sucks.  The New England Journal of Medicine suggests less than 8% of hospitals have even a basic electronic health records system, and less than 2% have a system that’s “comprehensive.”  Yet all 1,4000 hospital and clinics for the VA have used their EHR system, VistA, for years, and it’s been one of the keys to the VA’s success in creating the best health care system in the country.  The question I always get – why can’t hospitals just start using the VA system?

According to a recent profile in the Wall Street Journal, the answer is, “They can.”

The WSJ spends some time in Midland Memorial Hospital in Texas, which successfully implemented an open-source version of VistA.  The number one reason for the slow implementation of Health IT is the start-up cost, which is exorbitant to say the least.  Once you’ve selected a vendor, customized the software to suit your hospital’s particular needs, bought the server and computers to run it, install it and trained all of your staff to be on it, the average EHR installation for a good-sized hospital is north of $20 million.  By using the VA’s software free and open-sourced, Midland’s cost for adaptation, technology and training was only $7 million.  That’s still real money, but 1/3 of the price.

Anyone looking for reasons why we should be bothering with EHR at all should look at Midland’s results:

The system helped the hospital catch up on a $16.7 million coding and billing backlog for about 4,500 patient records in four weeks, which might have taken five or six months to do.

In the 18 months after the system went live hospital-wide in June 2006, the hospital reduced medication errors and patient deaths. Infection rates dropped 88% thanks to guidelines in the record system that prompted nurses to follow infection-control procedures, such as changing a dressing or following correct procedures when inserting a new IV.

Bed sores were also reduced as the system prompted nurses to turn patients in their beds at a set number of hours depending on their condition to prevent the sores. And Midland was able to increase by 77% its staff compliance with guidelines to care for patients on ventilators, which, if not followed, can lead to pneumonia.

So it helps their bottom line but, far more importantly, reduces preventable errors and increases quality of care.  It’s obvious why EHR has been embraced by other countries like Canada and Germany, and why the Obama administration has made the widespread adoption of EHR one of its top priorities.

It’s worth noting, before I get too wide-eyed about the potential, that there are problems with this implementation, and that frustration at dealing with Health IT has become its own cottage industry.  Some of this is natural to any adoption of new technology – it takes time to enter records; it’s “one more thing to do” for doctors and nurses who already have jam-packed schedules;  it’s a big encumbrance for the computer-illiterate;  and, of course, no technology is capable of solving all human error.  A frequent anecdote I hear concerns an individual VA doctor who enters information in a hurry by simply cutting and pasting all information from the patient’s previous routine visit, without bothering to check whether it’s accurate or not.  No computer system has a “You know what I mean” key.

And of course, individual implementations of open-source VistA don’t at all tap into the real power of having a nationwide adoption of Health IT.  If you’re in the VA system and traveling to another state when an incident occurs, they have all your information – including drug allergies – when you go to the local VA hospital.  When you switch doctors, or need to see multiple doctors at the same time for coordinated care, a lot of time and money is wasted in transferring and updating your medical record – shockingly enough, frequently by mail or FAX.  Having all of your doctors on the same system would save time and money.  But just installing VistA at a handful of hospitals doesn’t create an interoperable network.  These open-source systems don’t currently “talk to” the proprietary systems of McKesson, Blue Cliff, etc.  In fact, the VA system currently doesn’t even talk to the Department of Defense system!  It’s a huge problem that has to be tackled before widespread adoption will yield any of the cost savings enjoyed by other countries.

At the end of he day, we probably do have to walk before we run with EHR.  But it is important that we walk while waiting for the solution that allows us to run – Midland, the VA, the Mayo Clinic and other coordinated care centers running on the “medical home” model are proof that installing EHR directly leads to better patient care and reduced errors.  To be blunt, medical errors are never benign and often deadly.  Clearly, anyone following the tech industry for the past couple of years knows that the free market is capable of building a better mousetrap over time – but while we’re building the better one, we need to start pushing hospitals to adopt the “pretty good one” we already have in open-source VistA.

It’d be a bargain at twice the price.

(Photo credit:  Nuclear Fire on Flickr.)