Electronic patient records still worth investing in
As highlighted last week, the National Programme for IT has recently come under fire from the National Audit Office for being over budget and failing to realise its original promises (click here). Shortly after the article was published, I came across this interesting piece published in the Archives of Internal Medicine (click here), which also highlighted limitations of current attempts at using electronic health records (EHR).
The article refers to a paper published in the same edition of the journal, which calls into question the effectiveness of EHRs and clinical decision support (CDS) systems in helping health professionals stick to guidelines. According to the editorial there was "no consistent difference in guideline adherence among providers who used paper medical records compared with those who used either an EHR alone or an EHR with CDS". So is this another nail in the coffin for increasing use of IT in clinical medicine, and in particular for an electronic health record?
Actually, I don't think so. I believe that an EHRs can still offer cost-effective improvements in both productivity and clinical outcomes. Indeed, I agree with the editorial, which eloquently called for standardised data streams using a common format that can be imported with ease into an EHR. This is not as esoteric as it sounds, as laboratory information, clinical information, dictation systems and any relevant clinical data should easily be imported and exported into any clinical system. Standardised coding of any clinical information should be a basic procedure that could easily be shared between interacting computer systems interacting. This would make EHRs a rich source of clinical data. Furthermore, having these data in a standard electronic format would offer all sorts of invaluable research opportunities.
More importantly from a UK perspective, it would be fantastic to have all the clinical systems able to 'speak' to each other and exchange data with ease. Despite having a National Health Service (NHS), we seem to have a lot of computer systems that cannot interface with each other and when they do, it often involves complex procedures.
It is a shame we do not have such a universal standardised data system within the NHS (or for that matter the global health community) and perhaps the present situation is an opportunity to try to introduce one. However, the pessimist within me thinks that this will not happen in the immediate future.
Dr Harry Brown, editor-in-chief univadis
By Dr Harry Brown