The move toward EMR started in the late 1980s with an Institute of Medicine study and the subsequent formation of the Computerized Patient Record Institute. “There have been major bumps in the road” since then, notes Bellaire.
The inherent complexity of healthcare systems and structures represents the biggest obstacle. Consider all of the interactions and information handoffs — among medical practice areas, business functions, organizations, and even industries (healthcare, pharmaceuticals, and insurance) — that occur when an organization treats a patient for congestive heart failure, for example. Social workers, pharmacists, insurance representatives, and numerous doctors and nurses may interact with that same patient.
“That’s a very complex situation,” says Fickenscher, “even more complex than an integrated supply chain, which is relatively simple compared to what is involved when someone enters the hospital with a myocardial infarction.”
Nelson says that the sheer cost of EMR projects rivals only what many healthcare organizations have spent on building new hospitals. EMR projects for hospitals and large healthcare systems are typically quantified in the hundred-million-dollars range, which is a stretch for large healthcare corporations and out of the ballpark for physician groups with a an average size of 2.5 doctors per practice.
Plus, most physician practices are organized as partnerships in which profit flows into the doctors’ pockets rather than into funds for discretionary projects. For that reason, Nelson believes that one of the next waves of EMR innovation will involve “applications that are pushed out to the doctors via the Internet.” This application service provider (ASP) model would need to deliver the functionality at a low cost with minimal support requirements. “We’re still on the very, very front end of that piece,” Nelson adds.
EMR: The Inside Story
