EHRs, the new frontier

Electronic health records (EHRs) will be the cornerstone of healthcare technology, critical to the modernization of today's healthcare systems. The design, selection and implementation of EHRs, therefore, will be extremely important for healthcare institutions. After years of watching and waiting, now is finally the time for healthcare organizations to implement EHRs. A new report by independent market analyst Datamonitor predicts North American and European spending on EHRs in 2007 totalled over $4.4 billion. The report, “Opportunities in the Electronic Health Record Market,” expects the overall global EHR market to grow to almost $13 billion by 2012 - a compound annual growth rate (CAGR) of 23.8%.

Today, an EHR or electronic medical record (EMR) means many different things to many different people. Datamonitor defines an EHR as a computerized application that manages patient information over time for a group of users. An EMR is the clinical component of an EHR, the part of the record that documents patients' medical histories, symptoms, diagnoses, treatments, etc. Thus, EHRs include EMRs, but also contain financial, administrative, research and educational aspects of patient care.

This definition of EHRs reflects what Datamonitor believes an EHR should be, not necessarily what it is commonly defined as or available today. Furthermore, in the end, the definition of an EHR or an EMR is not important; what is important is that healthcare organizations have the ability to access and share data as needed and improve the quality of patient care.

The ideal EHR network is not yet available, but is attainable

In a perfect world, EHR end users will include various providers (hospitals, ambulatory care clinics, primary care offices, physicians, nurses, etc.), ancillary departments (radiology, laboratory, pharmacies, etc.), patients through a Personal Health Record (PHR) portal, public health departments and payers (insurance companies). Researchers and pharmaceutical companies may even be involved in analyzing data from EHRs. However, each of these user groups will only have access to aspects of the EHR for which they are authorized.

Every hospital and physician office will have its own EHR and EHRs from different hospitals and physician offices will be interoperable to promote local, regional and/or national (perhaps even global) sharing of information. Just as an ATM card can be read in New York and New Delhi, EHRs should be able to one day connect worldwide as well.

Cost is the most significant, but not the only, barrier to adoption

In the cash-strapped and fast-paced healthcare care environment, technologies like EHRs that require time and resources to implement are difficult to adopt. Even EHRs that claim to be free have costs. Furthermore, the sheer number of vendors offering products in the EHR space and the inherent fragmentation within the healthcare community does not make EHR adoption any easier. Providers are also still hesitant to change the way they have been practicing medicine and sceptical of available technologies, especially concerning patient privacy and physician autonomy.

According to Christine Chang, healthcare technology analyst with Datamonitor and author of the study, “although the cost, complexity and change providers face will hinder the adoption of EHRs, EHRs will become a ‘must-have' for healthcare organizations. They will help transform the healthcare industry from today's reactive, frenetic environment to one that is more proactive, informed and leverages planned workflows. The quality of care patients receive will improve, the information available to clinicians will increase and the speed at which collaboration for patient care, public health surveillance and medical research takes place will be nearly instantaneous. While the implementation process is liable to take years, there is no turning back.”

No one-size-fits-all, but EHR adoption will increase if approached from many angles

The potential for EHRs is not difficult to comprehend, but widespread adoption of the technology has been painfully slow. Moving from today's single digit and low double-digit adoption rates to 100% usage will require planning, time, resources, incentives, sharing of information and perhaps, most importantly, a change in attitude on the part of providers. Positive publicity will be key; EHR success stories have been overshadowed by accounts of failures.

National EHR adoption strategies will of course differ by country but they will also fall into two main categories: top down or bottom up implementation. Financial and legal incentives, in addition to public recognition and sharing of best practices, will also encourage more healthcare organizations to implement EHRs. Datamonitor believes that using all these strategies together will increase EHR adoption among providers most effectively.

No need to reinvent the wheel: EHR technologies are already available in other industries

With more products to choose from and customers with increasingly high expectations, vendors need to be aware of the current technological trends and adapt their solutions or be left behind. Brand names will not be enough to carry sales. Healthcare organizations and EHR vendors should look to other industries to see where EHR technologies will be moving towards in the future. For example, Datamonitor believes that the software as a service (SaaS) model is and will continue to be favoured by end users, particularly in the ambulatory market but also among smaller hospitals. Additionally, build-it-yourself EHRs are no longer essential, even for large hospitals. Finally, as EHRs become more advanced, they will require solutions from multiple vendors.

Chang concludes, “Recent remarks by high profile healthcare technology experts calling EHR adoption ‘an ugly, ugly process' and a ‘nightmare' are counterproductive. The EHRs available today are much more advanced and easier to implement than those used by early adopters. Nevertheless, EHR technologies still have a way to go before the healthcare industry enters the 21st century.”