There are a number of reasons why e-health efforts have not moved more quickly. Privacy has been a major concern, with fears that insurance companies might deny coverage to people they know are suffering from an illness, making the security of digital records vital.
Cost is another major factor. Electronic health record systems can cost between $20 million and $200 million, a big investment for hospitals in the middle of a recession. Bumrungrad's tab was less expensive because it worked with Global Care Solutions to streamline its system, and as a private hospital operating in a relatively low-cost environment, it was able to set aside more funds for new technology.
The New England Journal of Medicine study says U.S. hospitals cite cost as the top barrier to building an electronic record system, followed by concerns over maintenance cost and resistance from physicians. The huge budget passed by the U.S. is an attempt to solve the funding problem, but even that figure "is a long way from being sufficient to cover the total cost," according to market researcher Ovum.
But there is another hurdle, and one that Bumrungrad was fortunate not to face: the problem of legacy equipment. Ironically, hospitals that moved aggressively in the past to computerize their health systems may now face the biggest challenge in creating a unified electronic records system.
In the U.S., for example, IT systems entered hospitals through expert physicians and specialty departments, who often introduced various types of equipment and proprietary software from preferred vendors. Over time, the number of different IT systems multiplied at individual hospitals, making the collection of data into a single health record an integration nightmare.
One of the top medical centers in the U.S., The Johns Hopkins Hospital, for example, uses software from dozens of vendors, including Microsoft, GE, Eclipsys, Meditech, Siemens and SAP, running on hardware ranging from IBM to Dell to Apple and more.
Of course, Johns Hopkins is even unique among U.S. hospitals because it's a research hospital attached to a university, not just a care provider. The specialists working there demand the best tools possible for their jobs.
"We'd be reluctant to settle for a system that's 'good enough'," said Stephanie Reel, vice president of information services at Johns Hopkins. "We have very demanding scientists, doctors and nurses, so we go for the top of the line systems... and there's a cost associated with that."
The unique IT tools for each specialty area have created a complexity and cost that is not sustainable, she said. But many of the systems may not ultimately be necessary. Just as most people only use a fraction of the features in their word processing software, some specialty IT systems at hospitals may be overkill, she believes.
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