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More than 5 years ago in his state of the union address, President George W. Bush announced a goal that all Americans have electronic health records within 10 years. Since then, momentum has been building towards that target, but we still have a long way to go. A recent special article published online by the New England Journal of Medicine reported that less than 2% of American hospitals have a comprehensive electronic records system in place in all major clinical units.

According to the article, which was based on a survey of members of the American Hospital Association, electronic health records systems are more likely to be in place in larger, urban hospitals. Teaching hospitals and academic medical centers have also been leading the movement toward electronic health records. Currently, only 10% of American hospitals use a basic electronic records system in at least one unit. Twelve percent of hospitals have a clinical notes reporting system, and 17% have computerized order entry systems. A large number (approximately 75%) of American hospitals already have electronic laboratory and radiology reporting systems in place. These are small steps in the right direction, but still leave a long way to go.

The appeal of electronic health records among the public, politicians, and the medical community is mounting, thanks to a growing, diverse American population, increasing socioeconomic health disparities, a medical system that emphasizes specialties over general practice, and a high incidence of medical errors. Ideally, electronic medical records will increase the efficiency and effectiveness of the provision of medical care, and reduce medical errors. An electronic health information system should provide information security, utilize common standards, exist in the public domain, provide support for all realms of health care, offer flexibility and responsiveness, and use standard Internet protocols and software. Electronic health information systems can include discharge summaries, electronic prescribing systems, anesthesia information systems, clinical note systems, clinical decision support, and many more tools.

So far, electronic health records systems have developed slowly in the United States. Strategies have primarily focused on improving immunization registries, regional health information networks, and insurance company projects. In part, the United States has been slow to implement universal electronic health information systems due to the lack of socialized medicine. Many European countries have an overwhelming majority of patients and health care providers participating in electronic health record keeping owing to the standardization and socialization of health care. American hospitals and health care providers currently choose their own vendors for software and training of electronic health information systems, leading to far-from-standardized record keeping and an inability to share information among providers.

In February 2009, President Barack Obama signed into law the American Recovery and Reinvestment Plan, allocating $20 billion to implement electronic health care records and provide training for health care staff that use the systems. While achieving the electronic health records standard by the 2014 goal set forth by the former president is highly unlikely, this financial stimulus may provide the impetus that the medical community needs to adopt electronic medical records. Adopting these systems improve the quality of care, patient safety and satisfaction, and overall efficiency. However, the costs associated with implementing electronic health information systems are prohibitive for many providers and hospital systems; further, the costs saved in the long run are not realized by the providers, but by insurance companies, patients, and society in general. Additionally, the successful implementation of the system requires lost productivity and a negative impact on workflow — hard choices to make in a time-crunched medical environment.

The lack of electronic health information systems in the United States represents a fundamental flaw in the provision of medical care today. This country is behind the times in this venue, and needs to commit the time and financial resources to bring the health care system into the 21st century.

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