Where Are We And Where Should We Go With Electronic Health Records?
Two articles in the New England Journal of Medicine now give interesting perspectives on this topic.
The first article shows just how far away the vision of a comprehensive EHR system still is:
[...] only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. [...]The second article is more of a position statement that details very clearly what we should have learned from the web about the design of an EHR platform:
The platform approach to software design can be used to create and sustain an extensible ecosystem of applications and to stimulate a market for competition on value and price.
First, there should be liquidity of data. The platform and its applications should reduce impediments to the transfer of data, in an agreed-upon form, from one system to another.
Second, there should be substitutability of applications. The system should be sufficiently modular and interoperable so that a primary care provider could readily use a billing system from one vendor, a prescription-writing program from another, and a laboratory information system from yet another.
Third, the platform should be built to open standards, accommodating both open-source and closed-source softwareThree points that should really be the blueprint for all large government organized IT-projects! (and, in fact, all large enterprise IT projects as well)