Ahead of the Storm

Attention surrounding the value and need for electronic medical records has never been greater until the Hurricane Katrina tragedy. As Health and Human Services' Secretary Michael Leavitt said, "There may not have been an experience that demonstrates, for me or the country, more powerfully the need for electronic health records than Katrina."

Thanks to records from pharmacy chains, Medicaid, the Veterans Administration and others, some displaced patients' medical and pharmaceutical records are being patched together to continue their care. But the toll of lost data on patient care and preventable errors will never be known.

This month the "State of the EMR" is our cover story. We even offer a few lessons Katrina taught Mary Bird Perkins Cancer Center in Baton Rouge, La. But as Poudre Valley Healthcare in Fort Collins, Colo., that implemented an EHR (consisting of many EMRs across hospitals, clinics, pharmacies and health insurers) has found, it can be cumbersome to interface with other outpatient practices using EMRs. The upshot? Profiles from the Integrating the Healthcare Enterprise now being tested may help, but may not completely solve the multi-vendor EMR integration challenges. Hope is that the IHE cross-enterprise document sharing profile will link records by offering a document registry that maintains a database of all known clinical documents, their location and associated meta-data.

EMR adoption rates are running between 15 and 20 percent for physician practices and 20 to 25 percent for hospitals. But overall, adoption of EMRs by private, office-based physicians has stagnated at about 17 percent, a National Ambulatory Medical Care Survey says.

Widespread EMR adoption could bring big savings - with two recent RAND Corp. studies showing EMRs coupled with interconnectivity and effective usage could annually slim $162 billion (with a B!). What will bring the savings? Slashing adverse drug reactions, adding CPOE, better management of chronic disease and more preventive care for all.

And what's the hold-up? High initial acquisition and implementation costs; slow and uncertain financial payoffs for providers; disruptive implementations for physicians; and payment systems that result in most savings going to insurers and patients but paid for by providers.

We all need to continue the push for a national health information infrastructure with standardization among healthcare information systems - before another disaster strikes.