November 04, 2008

 EMR in the Hundred Days

Should Mark's list of fast-track public investments for President Obama's "Hundred Days" include a start on the national electronic medical records system?

At first sight, no.

The main lesson from the near-fiasco in England is that you have to plan it right and get stakeholders on board. According the British National Audit Office, the cost of the programme is now under control. This has stabilised at 12.7bn in 2004 prices, but full implementation has slipped to 2014.

A close look at the NAO report suggests a more complicated picture. The main delay is in rolling out the core local medical records systems for GPs and hospitals. One key software suite had not yet been delivered by mid-2008. The US will presumably adopt a more decentralised approach based on common standards and software certification, which will take even more planning and consultation. It doesn't make sense to throw money at records systems until you have the standards in place.

But other parts of the English NHS project have proved much easier. The following bits of infrastructure are more or less complete:
* a dedicated broadband VPN with secure e-mail and smartcard access for healthcare workers
* the infrastructure for spine records (for now these are mostly just the patients' NHS numbers, but two areas have uploaded the skeleton medical information)
* regional medical image archives for scans
* electronic prescriptions
* a booking system for hospital admissions
* personal (patient-controlled) health web pages.

It looks to me as if it could be worthwhile for the USA to spend money quickly on the bits that are (a) technically straightforward and (b) don't depend on the details of medical records. The prescriptions and booking systems are probably too much tied to the peculiarities of the NHS to be reproducible, but the secure VPN and the image archives look like doable projects that would produce benefits to users right away.

Footnotes: The USA will need to keep much more administrative information about insurance. It can't use the Social Security number as the sole personal identifier: the system has to cope with foreigners too. The personal health pages cost next to nothing and and are good PR.

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