EMR: The never-ending debate

In the Netherlands, the discussions around Electronic Medical Records is once again in full swing. The crisis in the financial sector nearly fades in comparison... Some state that current plans are totally outdated, with Google and Microsoft about to change the landscape. "Time to take a step back and start over, while we still can." Others voice the opinion that we're far away from national adoption: "It will take years and years, especially considering the limited financial resources made available." Another group is adamantly voicing their opinion that the chosen architecture is inadequate. "This is never going to work. Besides, we have a new European standard. The choice for HL7 is totally wrong." And then there are those with the opinion that we should simply purchase a national license for a major HIS. Take Epic for instance: "It has everything you need and if we all start using it, the problem is solved." The noise of these never-ending debates is deafening.

In my opinion a few issues are often overlooked:

1) The EMR does not exist and never will. Each healthcare organization has its own information needs related to the type of care provided. They all have their own cultures, unique internal processes, widely varying partnerships with other organizations and their own internal priorities. The sum of all these variations simply cannot be covered by a single national EMR. Just like each company has chosen some accounting software package matching their accounting processes, the same way each company will have different wants and needs in an EMR solution. There is nothing wrong with that. What matters is that we can come to a national organized infrastructure for simple and fast exchange of data between EMR solutions. The National Exchange is therefore of crucial importance and needs significantly more attention. If the national power grid in our country had been deployed at the same pace as our national exchange for healthcare information exchange, half our country would still be in the dark ages.

2) Something is better than nothing. Whatever the opinion on current initiatives, it took a lot of time and effort to get where we are. Any new initiative will take another 5-10 years before it reaches the same level. There's no doubt that we now have more powerful and elegant technologies available than what's being used in initiatives so far. There's no doubt that there are disadvantages to the choices made so far. But we need something that works, more than we need something that is perfect. What is the objective here? To have the most technologically advanced solution? To use the "latest and greatest"? That we're regarded as "world leaders" in efforts like these? Or is it more important that we establish an adequate national infrastructure for healthcare information exchange that "works", against a reasonable price?

3) Many of the supposed contradictions are no contradictions. Often it concerns developments that can complement each other. For instance, the rise of consumer driven healthcare can be a strong stimulant to the establishment of a National Healthcare Exchange (NHE). It is nonsense to state that we no longer need an NHE with the arrival of Google and Microsoft to the scene. Quite the opposite. The NHE provides the infrastructure that will enable companies like Google and Microsoft to successfully deploy their consumer oriented products. It provides necessary ingredients for successful consumer driven healthcare. How else will the flood of information from all these consumer driven solutions lead to an organized personal health record? Similar logic applies to the differences between international standards like HL7 and national standards like the Dutch NEN13606. They can complement and add value to each other rather than be mutually exclusive. And that applies to the discussion about regional versus national initiatives as well. The answer is and, not or.

It is time we collectively start working on making sure that Nictiz and related aspects become a resounding success. Because right now, we're spending too much time on creating a self-fulfilling prophecy. And that is a shame.