Over and over I hear some doctor or EHR industry person say, “Why doesn’t the government just provide one EHR for all of healthcare?” Usually this is followed by some suggestion that the government has invested millions (or is it billions?) of dollars in the Vista EHR software and they should just make that the required national EHR.
You can see where this thinking comes from. The government has invested millions of dollars in the Vista EHR software. It’s widely used across the country. It’s used by most (and possibly all) of the various medical specialties. Lots of VA users love the benefit of having one EHR system where their records are always available no matter where in the VA system you go for health care. I’m sure there are many more reasons as well.
While the idea of a single EHR for all of healthcare is beautiful in theory, the reality of our healthcare system is that it’s impossible.
I’ve always known that the idea of a single government EHR was impossible, but I didn’t have a good explanation for why I thought it was impossible. Today, I saw a blog post called “Health IT Down the Drain” on Bobby Gladd’s blog. The blog post refers to the $1.3 billion over the last 4 years (their number) that has been spent trying to develop a single EHR system between the Department of Defence (DoD) and Veterans Affairs (VA). Congress and the President have demanded an “integrated” and “interoperable” solution between the two departments and we yet to see results. From Bobby’s post comes this sad quote:
“The only thing interoperable we get are the litany of excuses flying across both departments every year as to why it has taken so long to get this done,” said Miller, the chairman of the Veterans Affairs Committee…
The government can’t even bring together two of its very own departments around a single EHR solution. Imagine how it would be if the government tried to roll out one EHR system across the entire US healthcare system.
I hope those people who suggest one government EHR can put that to bed. This might work in a much smaller country with a simpler healthcare system. It’s just never going to happen in the US.
Thanks for the mention, John. Hope to see you soon. I will be at Health 2.0 2013 in Santa Clara Sept 29 – Oct 2nd. Hope my bay area relo is over by then.
I hope to see you as well. It always makes for an interesting discussion. I’m hopeing to be at Health 2.0 as well. Just a few more details to work out.
Is anyone surprised that the government can’t get two departments to interact properly?
This is hardly the standard by which all should be judged.
I have long stated that rather than give cash reimbursements, the gov’t should have given out Vista. It’s not perfect, and docs would complain…but how is that different from now?
I’m pretty sure if given that platform as the foundation, you’d see a huge marketplace open up around it.
Without that kind of standard, especially for the data structure, creating a nationwide system is near impossible.
John Brewer’s post has helped me to “see the light”. I cannot believe I am saying this, because there was a time when I NEVER would have…but a single-EHR (and single-payer) system really makes sense. Wow, that sounds “un-capitalistic” AND cost-effective. John B. points out that a market would evolve around the single-EHR. I love how he points out that unhappy providers and an imperfect EHR would be no departure from current state.
No, I don’t believe it will come to pass. I believe millions and billions more will be spent on attempts at EHR interoperability, ancillary interfaces, standards organizations and the like…instead of on things like treating patients and paying providers a living wage.
Isn’t that what the government did with Vista? They offered with an open source license for free. There is a marketplace that’s formed around it. It’s just not that large.
I agree with John B. Offering incentives was definitely not the way to go. Many specialties do not accept Medicare or Medicaid, so there is no incentive or penalty. And honestly, with MU 2 just around the corner, I believe many physicians will just choose not to participate.
Nor is one EHR provided by the government the solution. Unfortunately, we are way too far down the road now, but much less government intervention is the answer.
Something to consider. Does anyone find it interesting that government is pushing so hard for docs to adopt all this technology and protect the patient’s privacy at all cost and yet, Medicare cards are still paper with no magstripe and contain your social security number. Hmmmm…. “Do as I say, not as I do.”
Regarding Bill’s comment on Medicare cards; keep in mind, at least as I understand it, that Congress would have to act to change the card. But with a Congress whose main desire seems to be to eliminate any government involvement in health care, followed by cries to shut down the government, don’t expect anything useful to happen. Remember, there are many in the House who believe that Medicare is a Commie conspiracy (think Ronald Reagan’s LP record).