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Last year, ADVANCE trotted the globe for a glimpse of electronic health record (EHR) efforts in foreign countries. While the U.S. pioneered health information technology (HIT), nationwide adoption lagged behind that of other nations. The world over, EHR projects met many of the same barriers--mainly, cost and lack of interoperability.
This year, we did another flyover, looking for progress made and setbacks suffered. The verdict? It's a whole lot of the same.
Canada: Overpromise, Underdelivery
To the north, EHR programs faced a cold blow as critics and auditors faulted leaders for squandering funds, but efforts haven't iced over yet.
Nationwide, Canadian Health Infoway reported new implementations, yet the adoption rate has not met expectations set at the beginning of the program, according to Walter Wieners, FHIMSS, managing principal of Walter Wieners, FHIMSS, managing principal of Walter Wieners Associates, Sausalito, CA, and co-chair of the Healthcare Information and Management Systems Society (HIMSS) Global Enterprise EHR Task Force. Infoway aimed to digitize 50 percent of records by the end of 2010, but reports put current levels around 17 percent. Even Canadian citizens have overestimated progress; according to a recent poll, 36 percent of respondents believe they have an EHR.
Earlier this year, e-Health Ontario came under scrutiny for granting millions of dollars in untendered contracts to external consultants, with little to show for it. The agency, which took the helm after a previous organization was dissolved, has already spent $1 billion to promote EHR adoption, but many providers have yet to switch. An auditor general's report released in October concluded e-Health Ontario was "lacking in strategic direction" and yielded little value for the amount taxpayers invested.
In light of its poor performance, the organization has undergone a change of command. The CEO stepped down in June, followed by the board chairman. The province's health minister resigned after the auditor general's report was released and, most recently, a health policy expert announced he would make a premature departure from the board. A new health minister is now in place, and an interim CEO is holding post until Jan. 1.
Now, British Columbia's EHR program is under audit, and it may have similar results. The program has already been flagged for potential fraud, involving questionable invoices that were approved by a former e-health official.
As provinces work to increase implementation, concerns remain about privacy and security. In July, Alberta health officials disclosed a security breach involving EHRs. A virus infected 150 computers and may have captured personal health information, including names, lab results and diagnoses. More than 11,500 individuals were notified of the breach, an action praised by province's privacy commissioner. The commissioner also concluded that appropriate security measures were in place, but improvements could be made.
Last week, a USB drive containing more than 80,000 patient records went missing in Ontario. Investigations are underway.
The UK: Money Matters
Like Canada, the UK made sluggish progress over the past year, and officials are rethinking their approach. Minor accomplishments like e-prescribing and booking platforms have kept proponents looking ahead, but overall efforts for a national EHR service are "significantly behind expectations," according to Gerry Yantis, global health care lead for Capgemini, Herndon, VA, and a contributor to the HIMSS task force. "There still is relatively little patient health data in the national EHR due to the slow rate of health community adoption, or agreement to share, and upload of data from primary and acute care systems," he said.
With providers still reluctant to join the nationwide network, leaders are restructuring the program into regional EHR efforts, which would make implementation less daunting and allow a more gradual transition. Officials also hope regionalization will be more cost-effective, Yantis said.
The National Health Service (NHS) recently aired its financial woes when its chancellor announced plans to pare down the National Program for IT, with up to $9.9 million in cuts. Some fear the entire program will be scrapped, but officials said that's not the case.
Despite debates about EHR's future, NHS officials have kept a keen eye on privacy and security; the nationwide Spine network has suffered no breaches, according to Yantis. Clinicians use smart cards and passphrases to control access to records, and providers are required to track which doctor accessed what and why.
Still, patients are cautious about who's accessing their information. A recently released 2008 study found 40 percent of the general public felt records should never be searched for research purposes, and 53 percent believed researchers should get consent before accessing a patient's data. As records increasingly move online, patients will have the right to "opt out," much like in the U.S, Yantis said, but it's likely most people won't choose that route if they know potential EHR benefits.
Australia: The Commercial Route
Down under, health leaders are still trying to figure out the best approach to EHRs. Australian officials initially aimed to develop a centralized e-health network, but found a single system too tough to swallow. In October, the National e-Health Transition Authority (NEHTA) announced new plans to leverage patient-controlled personal health records (PHRs) in building a nationwide network. According to officials, commercial PHRs like GoogleHealth or Microsoft HealthVault would speed adoption and still achieve the ultimate goal of going electronic. Data would be held in different locations, but a new indexing system would be designed to allow the exchange and aggregation of files for medical care, according to reports.
Medicare Australia was set to complete the development of a Unique Healthcare Identifier service in December 2009, which would help streamline health record exchange. Privacy advocates, however, are wary of making medical records more accessible, particularly to the government. Amendments to the current Privacy Act have yet to be passed, which could rankle PHR efforts.
New Year, Same Story?
Across the board, EHRs are still battling the same financial, technological and bureaucratic demons researchers identified last year. And Wieners isn't surprised. "These programs are extremely complicated, across all the different dimensions we covered in the first white paper, technically and organizationally," he said.
Privacy and security concerns are universal, as is clinician reticence regarding adoption. Frustrations abound, but there is hope. Denmark, Japan and Norway have made "substantial progress," according to Wieners. The Danes were even highlighted in a Time magazine article noting successful health programs in Europe. Every hospital, pharmacy and 98 percent of primary care physicians in Denmark use the country's centralized database, and records are linked through regional health networks.
Overall, the U.S. faired better in 2009. The nation still has basic issues to sort out, but HIT and EHR incentives in the American Recovery and Reinvestment Act (ARRA) have put some much-needed steam into the system. "The task is fairly daunting in terms of what it would cost to be fully implemented countrywide, but [ARRA] is the biggest initiative we've seen," Wieners said.
Still, he cautioned against making too many promises. "We're making a lot of progress here," he said, "but we get into treacherous territory trying to put a percentage to a year."
Cheryl McEvoy is an assistant editor with ADVANCE.
Related Content
Read about other global endeavors in our article archives.
References
"Canadians aren't sure about health care priorities: study". CTV Edmonton. Dec. 8, 2009.
"Chancellor: NHS Might Scrap Elements of its National EHR Project". iHealthBeat. Dec. 7, 2009.
Dearne, Karen. "Governments change direction on health e-records". The Australian. Oct. 13, 2009.
"Despite scandal, eHealth Ont. pushes on". The Canadian Press. Dec. 6, 2009.
Diotte, Kerry. "Privacy breach shocker". Edmonton Sun. July 9, 2009.
Ferguson, Rob. "Policy expert quits board of e-Health". The Star. Dec. 22, 2009.
"First step taken towards national e-health system". Press release. Australian Health Ministers' Conference. July 13, 2009.
Harrell, Eben. "Health lessons from Europe". Time. May 20, 2009.
Huber, Jordana. "Over 80,000 Ontario health records missing". Canwest News Service. Dec. 22, 2009.
McKee, Selina. "Public reluctant to allow researchers access to health data". PharmaTimes. Dec. 3, 2009.
Meissner, Dirk. "B.C. AG conducts e-health review amid scandal allegations". The Canadian Press. Oct. 18, 2009.
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