Nearly all British general practitioners use computer-based patient records, but most hospital physicians do not, according to a paper published in the Nov. 9 issue of the British Medical Journal. "It's incredible, nearly 30 years after the benefits of
Nearly all British general practitioners use computer-based patient records, but most hospital physicians do not, according to a paper published in the Nov. 9 issue of the British Medical Journal.
"It's incredible, nearly 30 years after the benefits of good clinical information systems were widely demonstrated and rigorously evaluated, that not all hospitals are paperless, and patients still suffer from the well-known defects of paper-based systems," said Tim Benson, managing consultant at Abies Ltd. in London.
The government and medicine worked together to remove barriers and provide incentives for general practitioners for computerize. But the opposite happened in hospitals.
"There are several reasons why it was technically easier to computerize GPs than hospitals, all related to scalability," Benson said.
What works for a small practice does not necessarily work for a hospital, he said.
According to Benson, changes are needed to provide professional leadership and economic incentives in both primary and secondary sectors. An early step would be to establish stakeholder organizations for clinical users and IT professionals covering all aspects of healthcare computing.
"Similar patterns of cooperation between clinicians and payers are found in all successful projects, including the developments in Denmark, and in the hospital sector of the Department of Veterans Affairs in the U.S.," Benson said. "If U.S. insurers had taken a proactively positive view to computing many years ago, we would not need reports like the Institute of Medicine's 'Crossing the Quality Chasm,' (National Academy Press, 2001)," he said.
Benson sees remedies at hand. New developments, such as HL7 version 3, SNOMED Clinical Terms, new patient record architectures, security tools, and Internet technology may provide the cornerstones for integrated patient record services.
"Today's technology is perfectly adequate for the task," he said. "We now know that traditional methods do not do the job, so innovation is the only option."
The U.K. National Health Service plans to deploy integrated patient record systems across the healthcare spectrum, using Kaiser Permanente California as a model. Kaiser's experience suggests that integrated systems play a critical role in improving patient care.
Allocating more money to solve the problem is not the solution. A study in the BMJ (Jan. 19,2002;324:135-143) disputed the widely held belief that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment.
"Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology," said lead author Richard Feachem, Ph.D., director of the Institute for Global Health at the University of California, San Francisco.