Managing Your Clinical Information Systems through Electronic Health Records

All players in the US health industry agree that electronic health records are desirable and will help lead to high performance. However, Accenture's experience indicates that players must first face some fundamental architectural issues relating to existing technologies.

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Industry, government and health care providers are all clamoring for electronic health records to reduce medical errors, leading to high performance.

A few years ago, the Leapfrog Group (consisting of more than 170 companies and organizations that buy health care) asked health organizations to implement computerized physician order entry systems as a way to reduce medical errors. The efforts of other countries combined with the anti-terrorism response and a Federal Drug Administration imperative to accelerate the progress of clinical trials have caused the US Department of Health and Human Services (DHHS) to consider the issue seriously.

President Bush and other national leaders have publicly called for development of a national health information infrastructure. The plans so far call for a hierarchical set of local/regional and state networks and finally a national network to facilitate peer-to-peer sharing of patient electronic health record information.

Health organizations are beginning to examine the implications of the government's plans. The government's plans mean that individual provider organizations will need:

• Their own electronic health records (EHR) systems that facilitate clinical process automation within their offices and organizations, and that also share and access that same information on these networks.
  
  
• Information that conforms to a number of messaging, data and content/vocabulary standards.
  
  
• An understanding of the defined standards that cover a wide variety of data and activities, and the ability to verify that fundamental and core elements of any planned implementation such as data representation and source level coding are not contrary to these standards.

Accenture believes that in the light of the inevitability of EHRs, all hospitals and health systems clearly need to consider developing electronic methods of storing and tracking clinical information.

However, these institutions need to face up to fundamental architectural problems with existing technologies:

• Scalability: At present, most vendors who sell to large organizations can support 5,000 simultaneous logons as a maximum and now, with EHRS, more will be necessary.
  
  
• Reliability: Electronic processes are replacing paper, but paper may need to remain as a downtime procedure. Accenture suggests health IT executives determine their IT vendor's support and downtime processes.
  
  
• Recoverability: Backup plans that allow work to continue seamlessly without interruption of the primary systems need to be in place in the eventuality of downtime or failure.
  
  
• Interchangeable vocabularies: The local vocabularies need to be replaced with government-specified code sets in order to support a portable, interoperable electronic health record.
  
  
• Integration: At present most electronic record systems do not integrate with those of other vendors.

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