Misconception - “Health care reform” will improve the delivery of care and offer us better care opportunities.

[Stephen C Schimpff]

In fact, healthcare reform is not about healthcare; it is mostly about paying for medical care for the uninsured and only somewhat about the rising costs of medical care. I use the term medical care here to emphasize that today American “healthcare” is all about treating disease and injury and very little about promoting wellness and preventing illness. The reforms being proposed are about addressing the financing of medical care but not the quality, the safety or the way that healthcare will be delivered nor who will deliver it given the coming shortages of professionals at all levels. Certainly it is important to assure access to care for everyone but don’t let that confuse you into thinking your healthcare delivery will be improved. It will not.

[Stephen C Schimpff]

I am familiar with the EHR developed at Medstar. It is effective and efficient and I am not suprised that your ROI is good. There is a downpayment for EHRs in the stimulus bill last winter and more in the proposed reform acts making their way through Congress. I have two, possibly three, major concerns about most of the EHRs available today. First the lack of intraoperability. The major vendors have good systems but they cannot communicate with each other so that a patient discharged from one hospital cannot have that EHR "read" when they go the ER of a different hospital in the same city. The bills in Congress seem to insist that this be corrected. The second issue is that most of the commercial systems have relaitvely weak physician documentation - to the extent that most physicians I have talked to a multiple hospitals with different systems all say that they like the order entry and results reporting and the image availability but will not use the documentation aspect. This needs to change. The vendors need to examine how physicians actually work and design the systems around that work pattern rather than trying to get the docs to change their work flow and patterns. Salar, Inc in Baltimore has done just that [Full disclosure - I am on the Salar board.]Finally, many of the systems designed for physician offices are cumbersome and actually reduce productiviity for up to six months or so. Given the tight schedules physicians, especially primary care physicians, must keep, this becomes an nonstarter.

Once some of these issues get adequate resolution, I am convinced, as Gerry Higgins is, that the EHR will have major positive implications for medical care, medical costs and patient safety.

[Gerry Higgins]

I have compiled a list of 45 peer-reviewed articles published in the U.S. and elsewhere that show, beside the benefits you have suggested, the tremendous impact of Healthcare IT which is a critical component of the Health Reform Act.

In our own 9 hospital system in Washington, D.C and Baltimore, MD, the ROI from installation of the EHR since 1996 has been tremendous - it has also reduced ED physicians time looking for information about a patient by 60% during that time period.