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Electronic Health Records

Electronic Health Records

Electronic Health Records

Dr. Steven Arnold, MD, MS, MBA, CPE, FHIMSS, president and CEO of Healthcare Consultants International Inc., and chief medical officer at CSW Group Ltd. in the United Kingdom, is regarded as a catalytic champion of the national electronic health record (EHR) implementation movement. Dr. Arnold has more than 17 years of senior-level healthcare experience and is a recognized consultant to the healthcare industry for quality, hospital contracting and utilization, implementation of EHRs, and the development of integrated delivery systems.

Dr Steven Arnold is perfectly clear when he says that he is fully behind the adoption of EHR, not only in the United States, where he works, but globally.

Talking about the value of use of Electronic Health Records in the working environment, Dr Arnold told the eMessenger: “Clearly, EHR adoption is a commitment we should all make in the US. We are continuously faced with inaccurate, unreadable or missing information that is of a critical nature to the care of patients.

“Enterprise-wide EHR systems cannot be delayed any longer in the US and barriers to adoption of systems must be overcome.”

Time for ‘global’ developments

Much has been discussed about the interoperability – or the lack thereof - of EHR systems, a fact that is remarked upon elsewhere in this newsletter. It is not all bad news, claims Dr Arnold, but it is clear that much work needs to be done.

“It is one of the barriers to EHR adoption and is being addressed at local, regional, and national levels,” he says. “We will begin to see the further development of standards.”

But not just on a local level, he insists. “These developments must be global, not just national, so that systems can communicate worldwide.

“We will begin to see development of network models, not dissimilar to the telecommunications industry. Finally, we will begin to see rapid development of Health Record Banks - ones that will coordinate disparate systems through APIs (Application Programming Interfaces).

On the thorny issue of data security, Dr Arnold is firmly in the camp that believes that the benefits of EHR outweigh what others perceive to be the disadvantages.

He says: “Secure internet has come a long way over the past decade. Encryption is just one of the ways of securing the data. But even with improvements, there is no such thing as perfect security.”

He goes much further, however: “We cannot afford to wait until the day comes, if it ever comes, that data can be 100% secure. We would encounter too much unnecessary morbidity and, yes, even mortality, if we do not get these systems up and running in the shortest time possible.”

Communication is key

As for the next steps – to improve the function and spread of EHR, Dr Arnold again takes the global view, saying: “We need to create new global standards and improve interoperability. Systems need to be enterprise-wide throughout integrated delivery systems of care.

“In other words, hospital, ambulatory systems and personal health records need to be able to communicate freely with each other. In addition, systems need to migrate to ultra-thin client web-browser based system and/or the data needs to be stored and backed-up off site.

Chillingly, Dr Arnold backs up his point with a recent example of a communication breakdown: “If we expect to avoid the health-care ravages of, say, another hurricane Katrina, we cannot keep our applications and data solely at one local site.”

As a HIMSS member since 2004, he has worked tirelessly managing HIMSS volunteer organizational units and has guided volunteers to achieve great outcomes in the form of tangible deliverables that enrich the culture of HIMSS and the healthcare industry as a whole. He has been a member of the HIMSS EHR Steering Committee for the past two years, chaired the EHR Implementation Subcommittee, and served as the editor and coauthor of two HIMSS books: Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid and soon to be published The Wireless Office.

He currently chairs the Wireless Health Information Technology Task Force as well as the EHR Global Enterprise Task Force, and is a member of the HIMSS Katrina Phoenix Advisory Board. As a Katrina Phoenix board member, Dr. Arnold has lent his EHR selection and implementation expertise to several medical practices in the Gulf Region. Additionally, for his exceptional leadership within HIMSS, Dr. Arnold was awarded the “Spirit of HIMSS” Award in January and December 2006.

Error Reduction Is Huge Plus With EHR

Kari Harno has much hands-on experience of Electronic Health Records (EHRs).

The Hospital District of Helsinki and Uusimaa consists of 24 hospitals, which provide secondary and tertiary care and, according to Mr Harno: “EHR supports the continuity of care among clinicians for improved health care provision.”

“The impact may also be seen as quality improvement. This happens by reducing errors and increasing the effectiveness of care,” he adds.

Benefits outweigh disadvantages

As weighed against paper records, Mr Harno has no doubts: “EHR definitely also adds elements for the improvement of data security when compared [to paper records].

On that issue of security of EHR, Mr Harno comes out strongly in favour of modern data systems, despite being aware of the concerns.

“Health care providers face a dilemma: on the one hand patient data need to be readily available; on the other hand, information needs to be protected from unauthorised use and against loss or modification,” he says.

The best-balanced solution is, in his opinion, “[by] creating a secure infrastructure by applying PKI and structured consent for data provision”. In such circumstances, the Finn insists, “the benefits of EHR within these realms far overweigh the possible disadvantages”.

Again, as is so often the case, health care professionals are acutely aware of interoperability issues, as well as security ones. Says Mr Harno: “The integration of different IT systems is key to seamless work flow between secondary and primary care. This is in order to create better co-ordination of services among different providers.”

According to the Finn, interoperability should secure this target “in the near future”.
But there is a proviso: “Integration should encompass not only messaging between providers, but create a virtual health record by allowing access to information stored in separate repositories.”

Closing the education gap

Asked about the most important challenges facing EHR and their implementation, Mr Harno says: “Security concerns as well as legal issues, need to be cleared.” Crucially, he points to an ‘education gap’, which he says must be taken care of.

“Roughly one-third of all health care personnel are currently able enough to get what I call an IT “driver’s licence,” he says. Apparently, this is not good enough.

“The usability of present IT solutions has to improve to cope with the needs of all user groups,” Mr Harno concludes.

Kari Sven Robert Harno, PhD is Chief Physician at Helsinki University Central Hospital. Currently coordinating the implementation of the Finnish national repository for healthcare (2007), Harno co-chaired in 2006 the working group tasked with the preparation of legislation on processing digital information in healthcare and social affairs.

Harno has been appointed in several occasions by the Finnish Ministry of Social Affairs and Health to participate in national working groups for a Finland-wide electronic health record, ePrescription and legislation to support the use of eHealth. In his position as Head of the Regional Health Information Network project UUMARhio, Harno was responsible for the installation and coordination of the network that brought together 31 municipalities and the Hospital District of Helsinki and Uusimaa.

After completing his medicine studies in Vienna University, Harno obtained his PhD and specialised in Internal Medicine and diabetology in his homeland, in Helsinki University. He is also an associate professor in medical informatics at Kuopio University.

Interoperability Showcase At HIMSS 07 Points The Way Forward

The HIMSS annual conference, held in New Orleans, attracted over 24,000 attendees from 34 countries and featured more than 300 educational sessions, further consolidating its status as the premier healthcare IT industry event worldwide. More than 900 vendors of healthcare IT products showcased their products on the exhibition floor. Keynote speakers such as Steve Ballmer (CEO Microsoft), Colin Powell (former US Secretary of State) and personal and management development author Stephen R. Covey (“7 habits”) underscored information technology’s appeal and relevance in the search of solutions to healthcare’s challenges.

The event brought to the fore the detrimental effect of the lack of technical standards. It is clear that healthcare IT users – hospital managers and directors, private physicians, public officials – want solutions to make their operations and systems more efficient and effective, and that vendors strive to make them. But the lack of standards is crippling the advancement of healthcare IT. Billing systems, privacy regulations, even alphabets vary from country to country. Basic parameters, such as the identification of patients, are not harmonised.

The result: on the showroom floors customers face a bewildering array of vendors and products that work well on their own. But few customers can build their IT systems from scratch, or want to build “IT islands”. They need products that work with their existing facilities and systems. Vendors also know that their products are part of a wider picture. The European Commission is now beginning to harmonise European systems with its FP7 ICT Work Programme, but it foresees a timeframe of four to five years. What is everybody to do in the meantime?

Interoperability is major building block

Absent binding standards, building interoperability among existing products is the only other solution. HIMSS has been convening medical specialists and other care providers, administrators, standards organisations, IT professionals and vendors to improve the way computer systems in healthcare share critical information since 1998, when it initiated Integrating the Healthcare Enterprise (IHE) with other organisations.

HIMSS 07 again featured the IHE Interoperability Showcase at which healthcare IT companies demonstrated that their systems successfully performed integration functions with others: visitors to the showcase could create their own electronic health record (or laboratory result, medical results, etc) and access it across multiple healthcare settings.

And, after leaving the showcase, attendees could visit exhibit booths of participating vendors to access their self-created personal health records, thus giving vendors a powerful incentive to display their IHE participation and compliance. More than 50 healthcare companies supported the showcase, with Europe, Middle East and Africa (EMEA) providers strongly represented.

IHE in Europe

IHE in Europe has been active (without HIMSS’ direct involvement) since 2001, and European vendors as well as users have been major drivers of interoperability. “Connectathons” – multi-day workshops where IT engineers from many vendors convene to test the interoperability of their products in real conditions – have become annual events. In 2007, the IHE Europe Connectathon will be held in Berlin during the eHealth week (Berlin Messe, Hall 6.2) from 15-20 April. Additionally, a European IHE Showcase is planned for The World of Health IT conference in Vienna, to be held from 22-25 October this year. For details, see www.ihe-europe.org, www.ihe.net.

A running joke at HIMSS 07 went that “the wonderful thing about standards is that there are so many to choose from”. Advancing standards will be crucial to the development of healthcare IT if it is to deliver efficiencies, productivity gains and other benefits for the delivery of healthcare. Until we have standards, interoperability is the best hope we have.

“Does HIMSS EMEA have any information that describes the healthcare environment on a country-by-country basis? In particular, I would like to learn more about healthcare in the Netherlands.

If HIMSS EMEA does not have this type of information directly, could you suggest a potential source?”

Thank you for your question and we are happy to help.

Any research on European health systems should start with the European Observatory on Health Systems and Policies, a partnership between the World Health Organization, a number of European governments, and some other actors.

Their website is at www.euro.who.int/observatory

Once connected, click on HIT country profiles (this stands for Health Systems in Transition, HiT). These are country-based reports – in PDF format - that provide a detailed description of each health care system and of reform and policy initiatives in progress or under development.

The current Netherlands report is from 2004 - but will have much of the type of information that you need.Further resources available include general information on NL heath care at http://www.justlanded.com/english/netherlands/tools/
just_landed_guide/health/healthcare as well as a backgrounder on the Dutch model at OECD Observer.
Weblink

Topical questions and answers on current Dutch health care issues are answered on the home website of the Netherlands Health Care Inspectorate.

Yet more information can be accessed at the site of The Dutch Institute for Healthcare Improvement (CBO).
Weblink

Meanwhile, for general information on healthcare country-by-country (including The Netherlands) go to http://www.who.int/
countries/en/ and, for specific information on home care across the globe, visit http://www.whho.org/WHHOcompidx.html

Finally, information on European health generally can be found at Health Information Network Europe (HINE). Weblink

Cordula Singer
HIMSS EMEA secretariat

Questions anyone?
Challenge us to help you with your (healthcare ICT related) questions. Send your input to emea@himss.org (subject line: question time) and we will research and publish your questions and our answers in forthcoming issues of the eMessenger.

The HIMSS Mission

The Healthcare Information and Management Systems Society (HIMSS) is the premier professional member organisation exclusively focused on providing leadership for the optimal use of healthcare information technology.

The HIMSS mission is to lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation and community affiliations. HIMSS EMEA brings this mission to Europe, Middle East and Africa.

HIMSS EMEA

HIMSS in Europe, the Middle East and Africa (EMEA) is dedicated to bringing together all the major players in the Health ICT community to transcend borders and languages and engender a truly regional dialogue. As members of HIMSS EMEA, individual professionals (managers, administrators, clinicians, technology experts and users), vendor companies and IT providers meet, interact and learn from one another.

With the opening of its EMEA office in Brussels, HIMSS is now positioned to provide activities, programmes and education specifically designed for the EMEA Health ICT community. Guided by a Governing Council of members from within the EMEA region, HIMSS EMEA focuses on the needs of individual and corporate members to ensure dedicated services and membership value.

Membership benefits include

• A monthly e-newsletter - HIMSS EMEA eMessenger – delivered to your inbox on the third Thursday of every month.
• A series of educational eSeminars on topics reflecting the challenges of the Healthcare ICT community in the EMEA region. In the first half of 2007 we will focus on Electronic Health Records (EHR) and IT Governance – the results of a joint AGFA and HIMSS study, as well as a webinar highlighting EU legislative trends affecting our sector.
• An interactive website targeted at the main issues and experts within our community. This includes a weekly “Expert View” on the issues that matter to you as well as industry news (RSS feed in partnership with Healthcare IT News Europe).
• Access to the latest industry and policy documents on the HIMSS EMEA online resource centre.
• Significant member discounts on the World of Health IT Conference and Exhibition, the HIMSS Annual Conference & Exhibition, the HIMSS bookstore and HIMSS events.

To learn more about HIMSS EMEA take a look at our website: www.himss.org/emea