Summary
The healthcare industry overspends on administration, relative to other industries. Automation through IT systems is clearly one of the solutions, but a centralised or uniform health records platform is increasingly not looking like the answer. The healthcare system is so complex that Electronic Health Records (EHR) adoption will be department by department, region by region, and practice by practice. Healthcare specialists rather than generalist systems integrators are best placed to design such solutions. The challenge for implementers would then be integration with existing systems and it is here than the maligned centralist integrators such as BT, sponsored by decentralised healthcare providers, have a role to play in future.
Analysis
The rationale for adoption of Electronic Health Records (EHR) is clear, even across two healthcare systems as different as the UK and US. But the low level of adoption, for a concept that has been around a long time, is striking.
EHR promises improved healthcare efficiency in future but the cost and upheaval of changing from legacy systems (including discovering and transferring data), and of making one uniform system work for all healthcare agencies, is keeping adoption low in both the UK and the US.
EHR is a 'spend to save' proposition that may be difficult for healthcare organisations to sanction over the next few years of tight public sector budgets in the UK and falling hospital profitability in the US.
So far, centralised systems such as those sponsored by the UK NHS’s National Programme for IT, have not come to fruition; and uniform systems in the decentralised US system have suffered very low adoption too. One of the impediments has been the complexity of the interlocking functions of the healthcare system. Most of the data in health records would be of interest only to the originator of the data; it is only the top slice of data that is useful for sharing between functions. For example, data for research purposes, or from bone densitometry tests, are in demand from the practitioners involved but the data they want is of use to nobody else.
Nevertheless, automation of electronic health records is progressing, in a piecemeal and decentralised way. Some of the big UK hospital trusts, such as Newcastle, have opted out of the UK’s national programme and have commissioned bespoke systems.
Record systems on the fringes of the NHS IT ‘spine’ and in primary care have been developed profitably by niche specialists such as Adastra and System C Healthcare.
Evolution from here should continue to be in fragments and piecemeal, with integration between each new EHR system and existing platforms a key role for sponsoring health authorities in partnership with the generalist integrators such as BT and Fujitsu who so far haven’t been able to make centralised systems work.
For the core records systems themselves, the US-based healthcare specialists such as University of Pittsburgh Medical Centre and Kaiser Permanente are well-placed to serve not only autonomous US hospitals but also those UK hospital trusts that have come to appreciate specialist healthcare expertise rather than general systems integration skills.
Local GP and physician practices, often thought of as the laggards, may end up leading the adoption of electronic health records, since their systems or simpler, integration needs are fewer, and the incentives, chiefly those on offer from the new US administration, are more tangible.
