When it comes to the history of electronic medical records, C. Peter Waegemann can take the long view.
Waegemann, the chief executive officer of the Medical Records Institute, which promotes of the annual Towards the Electronic Patient Record trade show running this week in Baltimore, said when the show first started back in 1984, almost no one in healthcare was using a computer for clinical purposes and virtually no physician office had an EMR system.
Still, Waegemann recalled, "People thought in three to five years, doctors would have them." By 1991, when the Institute of Medicine issued its report The Computer-Based Patient Record: An Essential Technology for Health Care, the timeline stretched on most projections to 10 years, he said.
Waegemann said there have been several subsequent 10-year projections, including the most recent goal set by President Bush in 2004 that most Americans should have an electronic medical record in a decade. So, what's Waegemann's projection today? Ten years seems as good as any number, Waegemann said, despite very limited adoption of EMR systems within hospitals and, particularly, physician offices.
A recently released survey funded by the CMS found that while 88% of hospitals surveyed used IT for lab results, just 21% were using e-prescribing systems; while testimony at a recent federal IT committee pegged the EMR adoption rate at 17% for physician offices.
Murray Bywater, managing director of Silicon Bridge Research, an IT consulting firm based in the U.K., gave a TEPR presentation Tuesday on the status of IT deployment in the U.S. and European nations, noting that while the U.S. is ahead of Europe in the adoption of hospital-based IT systems, the U.S. trails badly behind most European nations -- ranking 13th out of 16 -- in a recent survey, in the use of EMR systems by physicians. Most European governments subsidize the cost of physician EMR systems, Bywater said, with leaders such as Sweden and the Netherlands posting physician EMR usage rates well above 90%.
Bywater said his firm's market research showed that in 2004 nearly all European hospitals surveyed (98.9%) had basic electronic administration systems for patient admission, discharge and transfer, but just 17.6% had systems in place to handle order communication and document management, and only 2.1% had electronic prescribing with knowledge support.
Waegemann said the U.S. office EMR numbers aren't as bad as they may seem because the systems in use in physician offices here are typically more sophisticated that those deployed in Europe. Meanwhile, EMR usage here "in the one-to-three doctor field is really catching up," he said.
Waegemann also gave short shrift to the potential impact of personal health records offered by health plans and to regional health information organizations, or RHIOs.
"First, it's a nice idea," he said of the plans' PHR initiative. "But I wouldn't put one dollar into it. The same thing is going on with RHIOs."
"There is a lot of hype about patient empowerment," Waegemann said, noting that in 2001, at the beginning of the dot-com bust, 13 million people had electronic personal health records. "Now, we have about 900,000. All these people who are talking about patient empowerment haven't learned from the past."
The change ahead in healthcare IT will be from using computers as mere record-keeping machines to the opening frontier of computers at the heart of intelligent systems.
"We are finishing 20 years focusing on the electronic medical record and going to computer-supported healthcare, with the medical record just one part of it," Waegemann said.
This year's show, the 22nd TEPR, will draw more than 3,000 attendees and 180 exhibitors, Waegemann said.
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