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HIT Lessons from Across the Pond

Carrie Vaughan, for HealthLeaders Media, August 4, 2009

I often hear how other countries are ahead of the United States when it comes to using electronic health records and exchanging electronic health information. For example, Don E. Detmer, MD, president and CEO of the American Medical Informatics Association, referred to Scandinavia, the Netherlands, Denmark, the United Kingdom, Canada, and Japan as countries that are ahead of us in this arena at a recent Nashville Health Care Council meeting. "We can learn a lot from these experiments," he said, acknowledging that no one has it totally figured out yet. "It is a tapestry that has different bright spots."

That is why I found a recent report, Accomplishing EHR/HIE (eHealth): Lessons from Europe," by CSC, a global consultancy firm, so interesting. It focuses on those "bright spots" and pulls 25 lessons learned from initiatives in Denmark, the Netherlands, and the United Kingdom.

Granted there are key differences between these countries' efforts and the United States. The size of the European efforts is far smaller, for one. However, the initiatives are comparable and have encountered many of the same obstacles and issues. "The UK is 60 million people," says Fran Turisco, a coauthor of the report and research principal, emerging practices for CSC. While smaller than the US, "it is not eeny meeny," she says. Many of these countries also had a different starting place. In Denmark, The Netherlands, and Norway, EHR adoption by general practitioners is approaching 100%, compared to 20%, at most, in the United States, the report says. The U.S. effort is still focused on changing workflows and switching from paper to digital records in addition to exchanging data and becoming interoperable.

Turisco says that one of the most surprising results was that no one did any of these studies before, other than collecting anecdotal information such as the wait time for physician appointments. "We are spending billions of dollars easily, but there wasn't anything built into these initiatives to say, 'This is how we'll know we got value for our money,'" she says, adding that the UK is now going back and studying benefits. The U.S. is doing a better job on that front, she says, because the "meaningful use" matrix is tying elements like data capture, patient safety and quality reporting, and outcomes measurement to the technology.

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