Is "middle-out" the best Rx for health care IT?

Health reform efforts around the world are looking to electronic health records (EHR) as a means for squeezing more value and efficiency, and better outcomes fromhealth care budgets that appear to be consistently shrinking relative to demand. Health care in the US tends to take a “go-it-alone” approach, with policy makers loath to look overseas for readily applicable solutions for successful implementation. Despite this practical myopia, it’s probably worth considering the UK’s national experiment with EHR to get a sense of what the US might be in for as it straps on its climbing boots and prepares to scale the slopes of health care IT implementation.

A previous review of progress in the UK wasn’t very encouraging, you can read about that health care experience here. New analysis published in the British Medical Journal by Dr. Aziz Sheikh of the eHealth Research Group in Scotland and colleagues provide some overarching advice about EHR implementation. In 2002, the UK launched an ambitious plan to provide comprehensive EHR nationwide, backed by nearly $20 billion in funding. The UK approach was decidedly top-down: Backed by government mandates and standards. The US approach to date has been the opposite: A bottom-up process where providers and health care systems implement EHR somewhat randomly, and with no eye to overall interoperability.

Dr. Sheikh’s group characterized the UK experience as being “long, complex and iterative”. While the vision for useful, functional, interoperable EHR may still be realized, it may take decades to fully materialize. Among the complexities: Moving targets in the form of constantly evolving government standards; a variety of available EHR systems, with no clear indication of what’s preferable; the desire for local control and systems tailored to local context, rather than national-mandate; and uncertainty about the evolving EHR implementation program. Despite the complexities, stumbles and set backs, British practitioners are still supportive of adoption, clearly believing it will improve their practice or their professional lives. Dr. Sheikh and colleagues believe that the UK’s top-down approach may be one of the key reasons for the slow pace of change.

Post continues: www.justmeans.com/Is-middle-out-best-Rx-for-health-care-IT/30060.html