U.S. should look to Europe for e-health guidance

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A recently-published report on EHR and health information exchange (HIE) initiatives suggests that the United States should look at similar efforts in Europe as a guide for its development of large-scale e-health systems.

The authors, Harald A. Deutsch, MD, and Fran Turisco of the Computer Sciences Corporation (CSC), an IT and business services company headquartered in Falls Church, Va., paint a bleak historical picture of U.S. e-health initiatives. According to the authors, a review of 145 HIEs implemented in the U.S. found that only 32 of them are still active, while just 20 of those have achieved some level of success.

Although the Obama Administration has taken steps toward revamping state and regional e-health efforts with the enactment of the Health IT for Economic and Clinical Health (HITECH) Act, the authors warned that the complexity involved in eventually implementing a national health information network (NHIN) means it could take many years to accomplish.

Europe has been dealing with these issues for more than a decade, and many European countries have been able to implement large-scale e-health initiatives. The United Kingdom and the Scandinavian countries, according to the authors, have been particularly successful in implementing large HIE solutions. Even so, the European path to e-health system implementation has been varied and can provide some valuable lessons for future U.S. efforts, the authors noted.

For example, in the area of privacy and security, the issue of informed consent in the United Kingdom was settled rather easily by giving patients advanced notice and the opportunity to opt out of the system (an alternative chosen by less than 1 percent of patients), the authors wrote. However, in the Netherlands, informed consent was dealt with after much of the e-health system was built and ready to be rolled out. It was only then that patients were sent letters asking for permission, and 300,000 people--taken by surprise by the letters--responded by sending them back with incomplete or inaccurate information. Consequently, another round of letters had to be sent, leading to a delay in the system deployment.

The issue of IT requirements is another area that can lead to problems in e-health implementation. In Denmark, for example, authorities allowed IT requirements to be determined at the local county level, which resulted in a large number of failed EHR projects when there was no agreement on IT requirements and data sharing standards. Denmark has since shifted to a more centralized model, the authors reported.

Deutsch and Turisco said that with the enactment of HITECH, the United States is meeting best practices when it comes to the work completed for e-health planning, governance and communications, but still has to deal with complicated issues such as standards, patient consent, and patient identification.

Even when those issues are settled, the authors predicted that an enormous commitment of both time and resources will be necessary to construct or upgrade EHRs, in order to successfully connect them to local and, ultimately, a national network.