"In my opinion, there is not one successful EHR system in the whole world," said C. Peter Waegemann, who founded and ran the Boston-based Medical Records Institute from 1984 to 2009. "User friendliness, usability, and interoperability are not there," he added in an interview with InformationWeek Healthcare.
He defined a successful EHR as one that is fully interoperable. "We have been focusing too much on documentation [for the purpose of reimbursement]," he said. This point has not been lost on the Obama administration, which has warned providers about using EHRs to "game the system."
Still, Waegemann believes the administration has not been aggressive enough with its $27 billion federal Meaningful Use EHR incentive program, based on published rules for Stage 2 and early recommendations for Stage 3. "MU2 and MU3 are just small steps. They rely on old technology," Waegemann said.
He noted that a number of leading EHR systems are written in the MUMPS programming language that originated at Massachusetts General Hospital in the late 1960s. Meaningful Use also relies on outdated standards such as version 2.x of Health Level Seven International's messaging standards rather than the more recent version 3.
[ Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs. ]
According to Waegemann, too many organizations with EHRs still have paper forms and few EHRs are integrated with personal health records (PHRs).
"What we need is an EHR that is only an accessory to 'e-care,'" he said. Waegemann defines e-care as a patient-centric system in which technology serves as an adjunct to make healthcare more efficient. In his opinion, an EHR should include clinical decision support, the capture of clinical information at the point of care so the physician does not have to key in data, and automatic creation of documentation.
Meaningful Use does require physicians and hospitals to give some patients access to their records, but today's patient portals are "passive," according to Waegemann, in that individuals often are not able to enter their own information. It's not a personal health record, with patients truly in control, Waegemann contended.
He also said that the U.S. has wasted hundreds of millions of dollars on what first were called community health information networks (CHINs), then regional health information organizations (RHIOs), and more recently, health information exchanges (HIEs). Instead of regional networks, healthcare should look at point-to-point interoperability through standards.
"We need to have a totally different approach," Waegemann said. "What we need is an app that links anyone in personal care, from physical therapist to chiropractor to pharmacist."
Waegemann's Medical Records Institute put on an annual conference called Toward an Electronic Patient Record (TEPR) for 25 years. In the face of dwindling interest in TEPR, Waegemann reshaped the organization into the mHealth Initiative in early 2009, putting the focus on mobile technology in healthcare. The experiment lasted about three years until he quietly shut that entity down.
Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)