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Considering the time and effort spent on concepts of EHRs, one always ends up asking why they did not succeed. There must be substantial hurdles to prevent the great breakthrough of EHRs. And, indeed, there are substantial hurdles:
1. Information Capture
The main hurdle is get practitioners to use the computer for direct input. This involves several changes" one from free text to structured and interactive recording, the other change is from handwriting and/or dictation to point-of-care computer input. It must be recognized that the majority of EHR systems are more cumbersome and take longer to record. It has become a tradition in the medical informatics community to blame physicians and other practitioners for not being ready for the change to the computer. However, one needs to look at the motivation. Why should a practitioner (who is pressured in time) abandon the easy short handwritten note for a complex way of recording on a computer? Or, why giving up easy dictation for fiddling with small, hard-to-read screens on mobile healthcare computing devices?
It will take some time to overcome the hurdle of information capture. New and better devices need to be developed, and incentives for their use should be obvious to users and/or have financial implications.
2. Lack of Benefits
It is not easy to prove measurable benefits of electronic health record systems. Benefits are in the areas of (a) return on investment, (b) reduction of medical errors, (c) improved patient satisfaction, (d) improved practitioner and/or employee satisfaction,and (e) overall efficiency. An inventory of benefits of components of EHRs is currently created by the Medical Records Institute.
3. Lack of technical Interoperability
For the EMR, this means interoperability within an enterprise. This means, for example, that all systems within a hospital are interoperable" a patient’s demographics are only captured once. Every authorized practitioner should have full access to a patient’s health information stored within an enterprise. For higher versions (EHR, EPR, PMRI, etc.) this means technical interoperability independent of provider, medical specialty, geographic location, country systems, and legislation, etc. Currently, six different approaches are competing for being a platform for interoperability. They are OSI, CORBA, GEHR, HL7 CDA, OpenEHR, and the generic XML/Ontology approach.
4. Lack of interoperability for information representation
The second part of interoperability is in regard to having the same meaning in codes, vocabulary, terminology, context, and other means of information representation.
5. Lack of direct motivations
Why should providers spend substantial resources for EHRs? The need for sharing information is the main benefit of many EHR systems. Other benefits have only been realized in part (see the section on the MRI Survey below). |
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发表于 2003-8-4 22:35:54