Australia Ends $500 Million Electronic Medical Records Initiative

First United Kingdom ends their $17 billion electronic medical records initiative in 2011 and now Australia follows suit after 6 years of trying to fund their HealthSMART health information technology project and projected costs went from $318 million to $557 million.

This Australian project was to have provided hospitals with software from Cerner, iSoft (now CSC) and InterSystems... the same system which also failed to be implemented by United Kingdom.

I said it before and I'll say it again... I'm not surprised.

And I would wager that the United State's own electronic medical records initiative HITECH signed into law in 2009 by President Obama will also fail similarly though perhaps not as spectacularly.

It's hard enough to get a group of doctors in one hospital to agree with a treatment plan let alone agree to a medical records system. The problem is exponentially more difficult when applying it to an entire country.

Physicians practice medicine differently... just like teachers have their own unique way of teaching kids. A method that may work for one doctor or teacher will not work for another. Even the method may change depending on how "busy" things are (teacher with a class of 5 kids versus 30 kids) so a doctor in a busy inner-city emergency room will have different flows and needs from an electronic medical records than a rural family practice with a sedate pace. Furthermore, the needs of a dermatologist is very different from a pediatrician. One can't expect a single EMR system to meet the needs of both perfectly just like one cannot expect a math teacher to use the same teaching methods as a singing teacher.

Forcing physicians to use a single standard electronic medical records without adapting to these realities is bound to fail no matter how much time, training, software, and hardware you throw at it.

A better alternative (my opinion), is to treat electronic medical records like the computers they reside on. There should be many different types of EMR systems just like there are MANY different types of computer models, speeds, makes, cost, sizes, etc.

However, unlike current EMR systems, in spite of who makes a computer and what operating system software it runs, it has standardized components... USB, Firewire, HDMI, VGA, BlueTooth, etc. as well as a universal communication medium called the "internet" that works with phones, computers, laptops, etc regardless of who makes it and what software it is on.

You would think that an EMR system given its digital essence would be able to easily communicate with other systems... but no... they don't communicate at all... which is why paper reports still exist... which are than scanned into the EMR.

Rather than the government (whether the United Kingdom, Australia, or the United States) dictating what physicians must do and mandating EMR initiatives, I believe the money would be much better spent on mandating inter-operability and communication standards. The free market will create the best EMR systems and physicians will pick the one that best meets their need.

The other more insidious side of EMR is the over-reaching health goal mandates which means well, but runs into the same problem of applying standards to all physicians. Take "meaningful use" set by the Centers of Medicare and Medicaid Services (CMS). One of the core measures of meaningful use is adult weight-screening and follow-up.

Now as an ENT specialist, I see patients specifically for earwax. Why in the world would I want to perform a weight-screening when all I want to do (and what the patient only wants me to do) is get earwax out???

Makes no sense.

Does it to you???

Sources:
Government dumps hospital IT system. ABC News 5/18/12
Victoria kills HealthSMART IT project. IT News. 5/18/12

The Illusion of Healthcare Progress

Wellcome Film based in London has transferred numerous films dating from the early 20th century related to healthcare and medicine that anybody can view for free. Aside from the historical value, it is amazing that much of what we know and do now is not all that different than what was done in the 1920s. It makes me wonder sometimes what "progress" in healthcare actually has happened over the past century. In some things, tremendous change has occurred whereas in other areas of medicine, time might as well have stood still.

It also perhaps explains why in spite of all our "high-tech" medical equipment and sophisticated tests available in the United States that our health as a nation is still not as good as other nations without these benefits.

Take for example dizziness evaluation and understanding. Here are 3 films from 1925 that goes over dizziness evaluation and physiologic basis for it.

At its essence, nothing has really changed between 1925 and 2011. Sad really... Given this lack of progress, I would so far as to venture (with a straight face and all kidding aside) to say that American rates of dizziness is comparable to ANY other nation in the world with treatment protocols no better or worse too.

A New Method of Allergy Testing (Multi-Array Chip Technology)

A MIT researcher has developed a new and possibly more accurate blood test for allergies using multi-array chip technology. The paper is titled "Multidimensional analysis of the frequencies and rates of cytokine secretion from single cells by quantitative microengraving" and is published in the journal Lab on a Chip.

This chip technology uses a microscopic engraving process to create thousands to millions of tiny wells (or multi-array) on a chip where a different "blood test" can occur in each well. An overly simplified explanation of how testing occurs is as follows:

Inside each well, the chip manufacturer can place a different type of food or pollen protein such as milk or cat dander. A blood sample placed into the well will than allow allergic cells to "react" with the protein. If the cell (and therefore the person) is sensitized to the protein, the cell will release chemicals called cytokines that can be measured.

Given there are thousands to millions of wells, all of them microscopic in size, only a small amount of blood can be used to test for a whole array of food and pollen allergies.

Read the actual research here.

Unfortunately, our office does not utilize this innovative technology... yet... to test people for allergies. We use RAST. Using the results obtained, we are able to provide allergy shots or allergy drops.