Other nations lead U.S. in EMR development

No region of the world has yet achieved full electronic medical record implementation. But several countries taking a national approach are further along than the U.S.

Canada Health Infoway's first priority is to have the major components of an interoperable electronic health record in place across Canada within five to seven years, Marion Ball, Ed.D., an adjunct professor at Johns Hopkins University School of Nursing, told a HIMSS education session Tuesday morning.

Canada has budgeted close to CN$2 billion for this implementation. The principal impetus is to improve caregiver tools.

"Canada represents a compelling case for a single governing entity and the interplay between public and private coordination," Ball said.

In the U.K., the goal of the National Clinical Information System (NCIS) is to have a $3.9 billion medical record scheme in place by 2008. The NCIS will provide medical information for the nation's 50 million residents, including history and medications, to physicians anytime, anywhere.

Denmark's 5.3 million residents are served by the National Health Service. Its 3500 physicians have 90% of all patient contacts, and it expects to have EMR implemented in all 65 national hospitals by early 2006.

Others who have taken the national road are Sweden, Hong Kong, and Australia.

The U.S. approach, on the other hand, is market-driven and therefore fragmented. The most significant public and private EMR efforts to develop so far are found in the military and Veterans Affairs and the public HMO Kaiser Permanente, which serves nine million patients.

The proper mix of government and the private sector ingredients might lead to the greatest success in EMR implementation, Ball said.

Brazil is one country evolving healthcare relationships between the private and public sector.

"Brazil is exploring challenging territory with the use of an electronic health card as a patient and provider identifier at the point of care," Ball said.

Regardless of approach, factors apply in all environments, including several prerequisites:
? an adequate telecommunications infrastructure
? a clear conceptual model for an EMR system
? standards for terminology, data exchange, a unique patient identifier, privacy and confidentiality
? a scalable architecture

"What may work in one country may not be politically or culturally acceptable in another," Ball said.