Upon initial inspection, it appears the United States is lagging behind other major countries in EHR implementation. In fact, a report published by HIMSS in August 2008 entitledElectronic Health Records: A Global Perspective indicates that the U.S. has fallen behind “in many distinct and important categories of EHR implementation.”
For instance, despite the continued efforts of committees like Certification Commission for Healthcare Information Technology (CCHIT) and Health Information Technology Standards Panel (HITSP), the U.S. still falls short of having a centralized body of nationally accepted HIT standards. In contrast, Australia has established the National E-Health Transition Authority (NEHTA), which is charged with defining infrastructure and interoperability standards that are then adopted by state governments. In Canada, the centralized guide for EHR implementation is known as the EHR Solution Blueprint, and in England, standards are determined by the National Program for IT (NPfIT).
Funding for EHRs in the U.S. also pales in comparison with other countries. For example, Canada’s Infoway, a non-profit whose stakeholders include all Canadian federal, provincial, and territorial governments, had dedicated nearly $1.5 billion CAD to EHR implementation by the beginning of 2008 (Electronic Health Records: A Global Perspective). Australia, too, bolsters funding through NEHTA, another non-profit entity jointly funded by national and state governments. Perhaps the grandest funding effort of all can be seen in England’s NPfIT system, which has spent nearly £12 billion on coordinating a national HIE infrastructure.
But do these far-reaching standards bodies and centralized funding sources translate into HIE success? What about other factors that we at AI have been conscious of as we’ve advised clients planning an HIE, such as involvement of all key stakeholders, consideration of existing technologies and workflows, change management, and education outreach programs? The answer to this question is complex; but the success would have to be judged uneven.
One needs to look no further than England’s touted NHS system to see that funding and centralization, although enormously important, are only two components of the complex roadmap to HIE success.
Following initial predictions of £6 billion for the nationwide HIE project in England, the government is years behind schedule and has spent nearly twice as much as predicted. Though there were high expectations for many hospitals to implement the underlying HIE architecture, to date only one, Royal Free NHS Trust, has completed implementation. Other implementations have been stalled, as Royal Free NHS Trust continues to have major problems with the system and concerns are being raised about the value of money spent thus far. While proponents say they are not ready to throw in the towel just yet, critics have raised concerns as to whether the national system will ever reach completion.
Taking a step back to consider all the evidence, it seems that funding and centralization, while vital to HIE success, are nonetheless only pieces of an even larger and more complex puzzle. It is undeniable that the U.S. stands to learn some lessons from its European, Canadian, and Australian counterparts. On the other hand, stakeholder groups in the U.S., have made significant progress in spite of the apparent challenges.