It Really is Very Hard to Make Shared EHRs Work.

Sobering news for all the proponents of Shared EHRs came in overnight.

The original article from E-Health Insider can be found at the following URL:

http://www.ehiprimarycare.com/news/item.cfm?ID=2635

iHealthBeat (http://www.ihealthbeat.org/) summarises the key findings well.

“Majority of British Physicians Oppose IT Project, Survey Finds

Sixty-six percent of British general practitioners said they will not allow their own health records to be shared through the National Health Service's Summary Care Record program, according to a survey of general practitioners by Pulse magazine, E-Health Insider reports. Only one-third of respondents said they plan to advise their patients on sharing their health information.
The survey also found that:

• About one-third of physicians said they will allow full sharing of their patient records;
• Four out of 10 physicians say they will opt out completely from the program and allow none of their records to be shared;
• 80% of physicians surveyed still think that sharing electronic health records can threaten patients' confidentiality, despite a government marketing campaign to promote the IT program; and
• 67% of general practitioners oppose the implied consent "opt out" model, which has formed the basis for the program to be rolled out, E-Health Insider reports.

Lord Warner, the former head of the NHS IT program, said that physicians have become "over-protective" of their existing health record system, according to E-Health Insider (E-Health Insider, 4/24).”

The lessons here are clear. The first lesson is that the implementation of a Shared EHR is a project which must be undertaken with continuing and ongoing consultations with clinicians and patients to ensure the directions being adopted are acceptable and will foster adoption and use.

The second lesson it seems to me is that in 2007 the Shared EHR is not a technical problem but a cultural change problem where is the trust of the users of the system is not developed and maintained the risk of failure of the overall project failure is greatly increased.

The third important lesson is that if the approach adopted minimises compulsion, maximises patient control of their information and maximises voluntary choice as to whether to use the technology or not, assuming good technical design, while slower to reach, genuine adoption and use is much more likely.

Separate from this report, the interested reader is referred to my article of March 15, 2007 which is found at the following URL:

http://aushealthit.blogspot.com/2007/03/shared-ehr-can-it-be-done-simply-and.html

Without going over old ground it seems to me a simple Shared EHR can be very useful, but only if it is developed in the context of using the information from advanced clinical systems to provide information to and retrieve information from the shared record. Clearly the shared record also needs to be properly standardised and securely transmitted, received and stored.

All this is easily done, using standard and well tried technology. Making use of the record voluntary for both doctor and patient is the way to go. With a voluntary record, I am sure what will happen is that those for who having their record available is important the service will be used, and those who are unsure or uninterested simply won’t. It should really be as simple as that.

I suspect that among those with chronic and complex disease, in the scenario I suggest above, there would soon emerge pressure on clinicians from their patient’s to upload records as “information insurance” for the chronically ill as well as assisting in the overall co-ordination and delivery of their care.

We must make sure any Australian initiative to develop and deploy a Shared EHR has these lessons from the UK firmly in mind and approaches the project in a genuinely voluntary way!

David.