One of the hottest topics in healthcare is integrated care. More than 20% of Americans, for example, suffer from more than one chronic condition, such as diabetes, arthritis or heart disease. Potentially, they will have several doctors. But they do not have access to all their medical records, and may lack the knowledge to be able to convey details of their treatments to every medical professional who treats them.
A logical solution would be the provision of portable electronic patient records (EPRs)—universal medical files accessible on demand by care providers, allowing treatment decisions to be made in the context of the patient's complete history. Proponents such as Dr Volker Amelung, president of the German Managed Care Association, insist that without such records, "integrated care will not work."
Despite their potential to improve care and reduce costs, the adoption of EPRs has been exceedingly slow. In our survey, only a minority of medical professionals rate existing electronic storage and management of health data in their countries as good—23% in the US, 21% in Germany, and just 12% in the UK. Most describe them as acceptable, or even basic.
Barriers to their implementation differ between countries, but the result has been the same. The New England Journal of Medicine reported on a 2008 survey that pointed squarely at the lack of incentives for individual physicians. Only 4% had complete EPR systems, and another 13 % had simpler ones. By contrast, 66% said that the cost was the leading barrier to the purchase of such a system, and 50% worried about return on investment.
In Germany, Dr Amelung has seen no progress at all on the diffusion of EPRs. A lack of incentive to change plays a role, but so does risk aversion. He recalls viewing an advanced record system at an Israeli hospital when on a study trip with senior German health executives. "The German group talked only about data security, looking at what could fail, not at the added value for the patient," he notes. Given Germany's advanced IT sector, he says, "we could have had electronic patient records for years. Attitudes and incentives are holding it back."
In the UK, EPRs have been stalled by a traditional tale of bureaucratic innovation gone wrong. Launched in 2002, the government's £12.7 billion Connecting for Health programme—the largest civil IT project in the world, designed to provide an EPR system for all NHS patients—is running at least four years behind schedule. Officials will no longer even give an expected implementation date, and pilot projects have gone so badly that hospitals designated for installation have requested delays. In
March 2009, a leaked memo suggested that the Department of Health had taken over policy control from Connecting for Health officials, and was looking at allowing local procurement of systems around a national core rather than the single unified system foreseen under the plan.
Even when these problems are solved, others threaten to take their place. According to our survey, in each country the issues described above were only the second most frequently cited impediments to EPRs. Everywhere, respondents thought that patient worries about privacy remained an even bigger, unresolved concern. The barriers are different, but equally effective at blocking the kind of innovation healthcare needs.
