Global Thoughts on Waking the Health Care IT 'Sleeping Giant'

by George Lauer, iHealthBeat Features Editor

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Characterizing health care IT as a "sleeping giant," members of the Healthcare Information and Management Systems Society's Global Enterprise Task Force are working on the best ways to wake the giant up.

One kind of alarm clock might work well in some countries, but not in others.

The task force, which released a report on global electronic health record adoption this month, believes the more information shared, the better the waking will be.

"The task force and white paper come from the belief that there should be shared information between different countries," said Walter Wieners, co-chair of the task force who helped write and edit the HIMSS report, titled "Electronic Health Records: A Global Perspective."

"By visiting and learning from our counterparts around the world, health policymakers and advisers will be in a much better position to know what might and might not work. Leaders of Canada, Australia and the United States have met on numerous occasions to share insights, and I think each country has benefited from that," Wieners said.

The characterization of "sleeping giant" is the task force's recognition that although health care represents a significant amount of every country's spending, "health care IT lags far behind the technological capabilities of other global businesses including banking, telecommunications and the media," according to the report.

The HIMSS task force reviewed EHR implementations at health care IT centers in 15 countries in Asia Pacific, Europe, the Middle East and North America. Several other countries will be covered in the next edition due to be published next year, Wieners said.

The 16-member task force looked at various EHR components within each country, including security, quality, financing sources and barriers to adoption.

"Internationally, there's more experience involved in this report than you might think from simply reading the list of contributors," Wieners said, adding, "Many of these people have been intimately involved in the countries they're writing about for quite some time."

Careful Not To Lean Too Far

In simple terms, the two most basic tracks for developing EHRs can be defined as a government-led track and a private industry/free market-led track. The task force took special pains in compiling and writing the report not to lean too far toward one track or another, Wieners said.

"Models in different countries are very different with different mixes between public and private financing and public and private delivery," Wieners said, adding, "What is appropriate for one country is not necessarily appropriate for another. We tried to take that into consideration at all times."

The U.S. health care industry and government are struggling with that balance now, and Wieners said the task force was cognizant of the two views.

"There was an effort not to lean too much toward [the] government or free market way of doing things and I think we did that pretty well," Wieners said.

Wieners singled out the U.S. as a strong contributor to the efforts to create international standards and interoperability for EHRs.

"That's one area the United States has taken a leadership position in," Wieners said.

Patricia Wise, vice president of Health Information Systems at HIMSS, said looking at the big picture can help sharpen the focus on smaller parts of the picture.

"It's imperative to view health care IT solutions in the global context," Wise said.

She added, "By documenting what worked and what didn't, the white paper offers an expanded perspective on the progress and challenges of EHR implementation throughout the world."

Global EHR Lessons Learned

One of the report's objectives is to help the United States "avoid some of the mistakes while capitalizing on the successes of other countries' efforts."

As a sort of addendum to the 123-page report, Wieners identified eight common experiences recognized in an in-depth analyses of the health systems of Canada, Australia and England. Here are Wieners' summarized lessons learned by health care leaders from those countries:

  • Recognize that national EHR programs are industry-wide transformations developing within relatively immature health care IT environments. A key success factor is a critical mass and core leadership representing various levels in the health care industry not only to sponsor but also actively promote fundamental change industry-wide.
  • Building and maintaining genuine physician and clinician involvement in the political and implementation process is absolutely essential to program success.
  • Developing support from all stakeholders in the health care enterprise -- national, regional or provincial governments, as well as institutional and private providers -- is a recognized component of success. The active engagement and management of the vendor community is critical to the success of a national initiative, a factor that is overlooked in some countries.
  • Adoption and adherence to data exchange standards must be achieved early in the program planning process so that interoperative systems can be embedded into the overall system technical architecture.
  • Developing initial momentum among stakeholders is essential for building a critical mass of medical consumer and health care provider users of the system.
  • Achievement of national legal and regulatory agreement on privacy and consent issues of EHRs is an essential enabling component of national programs.
  • Substantial efforts must be applied to stakeholder communication to ensure successful participation and continued financial support for the program.
  • IT investment and deployment strategies and programs must be customizable. Each health care sector and the various health care delivery regions/organizations might be at a different point in their use of IT.


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