NHS exec says copying the U.S. is best way for U.K. to develop national connected digital medical records. But who will pay for it?
9 Mobile EHRs Compete For Doctors'
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More details have emerged about ambitious plans to roll out electronic health records (EHRs) in the U.K.'s socialized health system, despite the catastrophic failure of a previous $19 billion program to do just that.
It seems the apparently unfunded program takes its inspiration -- perhaps forgivably in the week of his Second Inauguration -- from President Obama.
A central IT executive in the U.K.'s National Health Service (NHS), Tim Kelsey, who holds the formal title of the NHS Commissioning Board's director of patients and information, has gone on record that English hospitals must have operational EHRs working in just over two years. Such systems, also called electronic patient records (EPRs) in the U.K. health informatics scene, are deemed vital by Kelsey as a hub for a slew of new data-driven patient services.
These services include patient-level clinical data feeds for a proposed national management system called Care.data, envisioned as integrating health and social care data for a whole new breed of local NHS managers (commissioners). But in his interview in a U.K. health informatics news site, E-Health Insider, Kelsey, who has acquired a reputation as a colorful speaker, is blunt when asked how all this EHR work is to be funded.
Basically, it won't be by him. "We're not in a position to put a massive investment into EPRs," he says. "I haven't got hundreds of millions of pounds."
Instead, he believes IT leaders in the NHS should take their lead from the U.S.'s network of 60 regional extension centers in accelerating the adoption of EPRs in American medical culture.
It's a model of clinical IT adoption Kelsey sees as highly successful, and one he is going to copy. "The biggest change in adoption in the U.S. came not from the Meaningful Use billions, but when [President Barack] Obama set up regional extension centers to train doctors and managers and develop and spread sustainable business models," Kelsey said. He seems convinced the spread of knowledge achieved by the centers was a more important factor in accelerating U.S. EPR adoption than the $9 billion so far channeled through the Meaningful Use initiative.
Readers in the U.S. may have a very different view, of course. Kelsey's plan also seems to fly in the face of skepticism about how effective such U.S. health initiatives actually have proven to be. Earlier in January, for example, a critical report from the RAND Corporation noted, "We believe that the anticipated productivity gains of health IT are being hindered by the sluggish pace of adoption, the reluctance of many clinicians to invest the considerable time and effort required to master difficult-to-use technology and the failure of many healthcare systems to implement the process changes required to fully realize health IT's potential."
To be fair, Kelsey says that the key to getting technology delivering for medicine probably lies in winning the hearts and minds of clinicians -- family doctors in particular -- which seems to have gone awry last time in the U.K. due to poor contract management and possibly unsuitable package choices.
The people who need to be won over in the NHS about the power of information technology, according to Kelsey, are not the "e-health digerati and cognoscenti [but a] hard-pressed general practitioner working in difficult circumstances on the front line, who sees [talk of EHRs] as nonsense or a whimsical distraction."
Commentators are already starting to wonder who is spreading the most whimsy here.
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