Too much emphasis is being placed on individual physician office EMRs. When individual practices implement a stand alone EMR that’s not connected to others it’s marginally better than paper systems. The problem we have in medicine today is that most physician offices are mom-and-pop shops that don’t invest in the same systems or connections to the other physicians, hospitals, labs and 3rd party payers.
This isn’t surprising because most offices can barely afford the $15 – $30K per physician to implement a good EMR system and go paperless in their offices. Interfacing to all of the other offices, labs, hospitals and 3rd party paryers that are involved in the care of their patients would require an investment far greater than what was spent to digitalize their offices. Maintaining these interfaces is also very cost prohibitive.
The US government has failed in its responsibility to set interoperability standards and as a result most systems that are implemented at the office level cannot talk to other offices, often if the other office implemented the same system from the same vendor. One of the reasons the government has failed is that we don’t have a single payer system. A single payer system is distinct from a nation wide singer payer. Like Germany and other countries the government should be the single collector and distributor of premiums but we could have private adjudicators. In this scenario everyone would be adhering to the same rules and all computers would share the same underlying database build but would be free to choose from a large number of vendors.
Examples of this are the standards for rail systms where almost all railroads share the same track gauge so that a railroad car can travel coast to cost without having to unload and reload it’s contents. Another example is that all of us follow nearly identical rules of the road when driving so we can take our cars and travel anywhere without having to switch sides of the road or learn different traffic signs. Most cars also share similar controls.
Unfortunately those underlying rules are not present in the electronic medical record arena so there’s no easy way for the information collected in one doctor’s office or hospital to flow with the patient to other facilities. Until that happens we’re going to continue to flounder and not make much progress in the digitalization of health care. We may also continue to see marginal incremental gains instead of the large savings and efficiencies needed in medicine in order to meat future demands.