The EHR era is here-really, it is

May 1, 2006

After years of delay and confusion, the electronic health record (EHR) is happening now, says a prominent physician expert in that arena.

David Kibbe, MD, MBA, head of the center for information technology at the American Academy of Family Physicians, told Contemporary Pediatrics: "I know most of all about small and medium-sized practices, like those of pediatricians, family physicians, internists, and neurologists. The biggest thing that is going on there is that they are very rapidly acquiring this information technology. And we have gone from about 10% of our [AAFP] membership using an EHR in 2002 and 2003 to over 30% using them now, at the beginning of 2006."

What's happening? First, research shows that physicians are not computer-phobic, despite that myth, Kibbe asserts. And the price of the software, which has been one of the biggest barriers to implementing an EHR, is beginning to come down.

Kibbe also pointed out that donated technological support could, alone, be highly valuable in getting practices past the dread of having to make a system work: "Even if you buy an EHR in your practice, you still have to plug it in, hook up the wireless network, and configure it."

All parties: Please keep talking

Kibbe called for dialogue as hospitals and integrated delivery systems offer products and services to physicians.

"They need to spend the time and energy necessary to understand ambulatory care information management and to see information technology acquisition and use from the point of the practices, not just the perspective of the hospital."

That's particularly important, Kibbe says, because there is something of a divide between, on one hand, health information technology vendors and companies whose products and services are provided to the hospital industry and, on the other hand, those who work in outpatient and ambulatory care environments. It is important to preserve choice, he says, because some products "are very innovative and are sold by companies that really understand ambulatory care workflow and communication processes much better than others."

Another factor to consider, Kibbe explains, is that it is getting easier for communication to go back and forth among laboratories, hospitals, doctors' offices, and diagnostic centers in a way that doesn't force everyone to join a private network. At the physician and medical-practice level, he says, "The EHR is fast becoming a sort of central nervous system for that practice-much more than simply creating documents electronically, although that is nice. The major value of EHR applications to the doctor's office is their ability to communicate-their ability to interact with other information sources."

Along those lines, Kibbe believes the melding of e-prescribing and the EHR is not all that far in the future: "Those of us who are physician informaticists are working on the standards layer so that this information can be interoperable between the pharmacy information systems and the EHRs used by physicians. Some of the same things are happening in the hospital industry."

What's next to roll down the Hill?

Meanwhile, says Kibbe, it's still hard to know what will come out of proposed federal legislation for the EHR. Washington staffers and health policymakers, he notes, are sounding a cautionary note more often these days and asking questions like, "What are we really trying to do? Does it really have to cost that much? Why would health information be different in terms of networking than other types of information?"

Kibbe cautions that current legislation only proposes resources in the range of $15 million to $20 million-"a drop in the bucket, when you consider that the Defense Department spends $1.9 billion dollars on its electronic healthcare system."