The Bottom Line According to The European Union is that Shared Electronic Health Records Are a Very Dubious Project.

A colleague who is trying not to cause too much trouble developed this short commentary on the below named report. He has given permission for it to be re-used.

The full report (58 pages) can be downloaded from here:

http://www.e-health-com.eu/fileadmin/user_upload/dateien/Downloads/eHealthStrategies_Final_Report.pdf

Review of the Final Report on National e-Health Infrastructures for the European Commission

While the report is relentlessly upbeat and positive, for a number of understandable reasons, buried in the document are a number of very important messages, key among them that shared record systems are failing to deliver benefits, especially given the enormous opportunity costs of pursuing them. Following are two extracts from the executive summary.

“So-called electronic health record (EHR) systems are a consistent element in almost all strategies and roadmaps. But usually EHRs are not well and/or consistently defined, often (implicitly) referring only to a patient summary or similar basic electronic patient re-cord. It is also increasingly evident that clinicians? enthusiasm for comprehensive electronic health records, which may connect patient data in diverse record systems at hospitals, community services etc., relates to perceived benefits in their immediate surroundings (their day-to-day work processes) rather than to a geographically widespread sharing of detailed patient data.

This is saying that clinicians are finding little or no value in shared EHRs.

“Reaching agreement about eHealth strategies and, even much more so, implementing them has almost everywhere proven to be much more complex and time-consuming than initially anticipated.

This is saying that putting in shared EHRs is extremely time-consuming and costly, going way over budget (we are talking billions of Euros here).

In addition, the complexity of eHealth as a management challenge has been vastly underestimated. It is here where an exchange of experience gained, also from failures, and lessons learned may prove particularly beneficial to Europe.

This is saying that it hasn’t gone anywhere near according to plan and that no-one really understands what is going on.

Following are two paragraphs from section 4.

Touted for 20 or more years as the “holy grail? of eHealth, electronic health records (EHR), or more precisely EHR systems, are a consistent element of almost all national strategies and roadmaps. However, whereas EHR-like systems have been implemented or are under development in many healthcare provider organisations, covering patient data from within their own organisational boundaries, and also in various regional health-care systems, there exist hardly any at the national level. The urgent clinical need for large-scale national systems is being questioned more and more, as a recent English evaluation noted: “Clinicians? enthusiasm for electronic health records often related to perceived benefits on their immediate surroundings and did not necessarily relate to the NHS Care Records Service’s goal of geographically widespread sharing of patient data.

This is saying that an enormous amount of money and effort has been poured into something that no-one really wants. It is interesting that out of 27 EU countries only two have made an attempt at implementation.

Recognising that there is, as yet, no universally accepted standard definition, for purposes of this study, a patient's electronic health record (EHR) is understood to be a shared, integrated or interlinked (virtual) record of all his/her clinically relevant health and medical data independent of when, where and by whom the data were recorded. In other words, it is an account of his/her diverse encounters with the health system as recorded in a variety of medical records maintained by various providers such as GPs, specialists, hospitals, laboratories, pharmacies etc. In many cases, an EHR is understood to contain a patient summary as one of its core elements or artefacts. Across most countries, policy documents mentioning EHRs usually do not contain specific definitions, i.e. it remains unclear what is really meant. It seems that, for implementation purposes, mainly patient summaries or extended versions thereof are envisaged.

This means that no-one really knows what should be in a shared record anyway.

In my view the net effect of all of this is that the shared record bubble will soon burst (This will impact shared EHRs at all levels including regional ones) I am also aware through separate sources that key opinion leaders across the world are agreed that the end of attempts to create regional shared records is on its way.

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Really this pretty much says it all. And to add to this I heard that, staggeringly, the Secretary of the Department of Health, speaking at the Health-e-Nation Conference a few days ago, admitted in response to a direct question that there was not an evidence base supporting the planned approach and that Australia had chosen to go its own way because it ‘was different’.

I guess that explains why the recently released PCEHR ConOps is an evidence free zone. There isn’t any!

David.