British EMR Experiment Ends in Failure
While the Obama administration is in the process of spending billions on developing electronic medical records, the British government has concluded that its £12.7 billion national electronic medical records system is a failure and that “there can be no confidence that the programme has delivered or can be delivered as originally conceived.” The Telegraph reports that Andrew Lansley, the Health Secretary, said “Labour’s NHS IT Programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs.”
The two parts that have worked and will be retained have been a part of the U.S. health care landscape for some years. The first is a nationwide NHS email system. The second is Choose and Book. Choose and Book lets patients who have been given a password and a reference number by their primary care physician “choose where [one] goes for your first consultation by comparing the hospitals [one has] been shortlisted at” and book, cancel, or change one’s appointment online as well as by phone.
Health IT holds promise to improve quality and reduce errors. However, it also has the potential to increase medical errors if not implemented correctly.
Doesn’t the VA do a pretty good job of handling medical records?
As a tech nerd, I’ve read about docs in the 80’s and 90’s who coded their own EMR’s. The problem comes when people have to start dealing with compliance and other regulations. It just gets too complicated.
The U.S. government seems to have difficulty designing and implementing complex computer systems — the IRS and air traffic control system are two examples. By contrast, through a competitive learning process, private industry, such as cellular telephony, successfully implements new systems.
Wow! They actually succeeded in establishing a nationwide e-mail system for the NHS? That would be as opposed to the global e-mail system that every British person has used for over a decade now, and goes by names like Yahoo!, Google, AOL, etc., right?
With respect to the VA, there was an increase in productivity that most observers credit to IT investment during a period when Dr. Kenneth Kizer was in charge of the system. However, the VA has demonstrated reversion to the mean (performance of government bureaucracy) subsequently. Government agencies under extraordinary leadership can outperform for short periods, but this is idiosyncratic and not to be generally expected.
I also suspect that some of the VA’s relatively good performance for a while was because the veterans of older wars were departing the scene, but the veterans of Afghanistan and Iraq had not yet appeared.
According to the GAO, there has never been an outside audit of VA record efficiency. There has been at least one study showing errors in a sizeable fraction of its medical records. Apparently data entry is cumbersome enough that people use copy and paste to fill individual records. VA docs often complain that the records are so voluminous that necessary information is difficult to find. There have also been disputes about who has the power to correct obvious mistakes in them.
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