T.R. Reid’s August 23rd op-ed piece in the Washington Post, “5 Myths About Health Care Around the World” explores many of the common myths Americans believe about health and healthcare systems in other countries. Opponents of health reform in America often point to these myths as concrete reasons why we shouldn’t model changes to the American system after health systems elsewhere. The myths are:
You can find out why these common myths don’t hold water by reading Mr. Reid’s article. But if I may, I’d like to add one other myth to the list:
6. America leads the world in the use of ICT in health.
In fact, nothing could be further from the truth. Anyone who has traveled extensively or spent any amount of time living abroad already knows that America has fallen behind many other countries in Europe, parts of Asia and elsewhere in public transportation, cellular technology, utilities infrastructure, and in many cases standards of living; although that last one is debatable depending on what kind of standards you have come to expect. And while America does offer highly advanced medical diagnostics and therapeutics (if you can access them), we lag well behind many other countries in our use of information and communications technology (ICT) in health.
Throughout much of Europe, nearly all clinicians use electronic health records. Compare that with less than 25 percent of clinicians here. Because payment systems in other countries incentivize more efficient ways to deliver health services, you will tend to see more widespread use of telemedicine and remote patient monitoring solutions than you typically will find in America. There is also more widespread use of hospital information systems that use highly flexible, less expensive commodity software components and web services architecture instead of highly proprietary, legacy technologies that are remnants of a bygone era in computing. Clinicians love these newer systems because they are easier to learn and use. Administrators love them because they are less costly to acquire and maintain.
We still have an opportunity to regain America’s lead. Let’s hope we make some good decisions in the months and years ahead. I’ve had an opportunity to meet with many innovative companies and individuals who are working very hard to move America in the right direction. I think we’ll all get there a little faster if people can just let go of some of the myths that are holding us back.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
Trends in the U.S. are backwards:
We are encouraged to adopt EMRs, and make use of ICT.
Then we are told it will become mandate.
There is virtually no leadership in this endeavor, so we all research and purchase different systems.
Since the standards are barely standard, the systems can't communicate. (HL7 and CCR doesn't guarantee that my software can talk to yours...)
So now, the 11-20% of American physicians who tried to follow directions have made huge financial investments in our systems.
We can't just "convert" to something better because our data is all stored in proprietary databases.
Our ePrescribing still can't handle Scheduled narcotics, but we're required to ePrescribe.
How much smarter would it have been for the thought-leaders to first devise a useful standard, then develop a platform for the software, then develop the software, and THEN tell the doctors to go use it.
I'm a practicing physician, avid EMR user, and a degreed computer scientist. If this is hard for me, I can only imagine how hard it is for my colleagues.
Our ICT is fiercely limited by a lack of inter-system communication.
Interfaces are extremely expensive, and the cost is usually passed on to the physician (who has virutally no financial gain from investing in a lab or PACS interface).
Do the European countries with these impressive statistics support their physicians to adopt and use information technology?
Surely, they aren't putting as much personal time and capital into their technology...
I am totally sympathetic with the plight of docs in America. Yes, even the well informed, computer literate would have a hard time knowing what to do right now. Meaningful use is still being defined. Standards are not fully in place. Legacy solutions are being replaced by a new generation of much less expensive, web-based subscription services. And yes, clinicians in Europe have received generous stipends from government to invest in information technology. On the other hand, there are plenty of docs in America who generate very handsome profits from their practices yet steadfastly refuse to re-invest some of those profits back into their business whether its new furnishings for the waiting room or a contemporary EMR solution. So, perhaps now is the time for things to change. They had better change, or American medicine may go the way of American automobile manufacturing.
Bill Crounse, MD
Great post Bill.
More Americans should get out more. I love my country and consider myself a patriot (retired US Marine). But after having lived, studied and worked as a health informatician in a number of other countries (currently Brazil) I can tell you that the US population is losing contact with reality.
For a political comment; probably too much Fox News!
It eerily weird that I end up concurring with Dr. Segal's views. I would like to add that to a large extent, your own company, Microsoft, has not made it very simple to further the cause of making health care IT any more accessible or easy to implement for the average physician office. A simple example is that after all these years I still cannot transfer the use of Microsoft Office from one pc to another, when the first one dies; Windows Server allows only 10 users, and I could go on and on. Unfortunately, we physicians simply cannot pass on any of these costs to our customers, nor can we expect any recognition from payers to show for this. And, I am a 7-year veteran of EMRs.
In response to your statement "there are plenty of docs in America who generate very handsome profits from their practices yet steadfastly refuse to re-invest some of those profits back into their business whether its new furnishings for the waiting room or a contemporary EMR solution" I can say - if these physicians are making handsome profits without any EMR solution, what is the incentive for them to make such a huge investment, especially when the possibility that it will actually hurt their productivity is real, at least in the short term?
Honestly, I think its time for a change in how software companies do business. Since the business of medicine is nothing like other retail businesses, unless IT companies come with a better method of selling their wares, physicians are going to be reluctant users, and I won't blame them for it. You will better understand this concept when you put your physician cap on, instead of your corporate one, Bill.
Honestly, thanks for your comment. Yes, we could do better even at Microsoft. I must admit that I am a bit spoiled. I have access to our most advanced solutions, including automated migration from one operating system or application to another with full network backup. My productivity hardly misses a beat. I know that is not always the experience elsewhere.
I also appreciate your comment about "corporate hat", although I did practice medicine for some twenty years in a variety of clinical settings. I believe we are on the cusp of a tipping point in clinical computing. Future solutions will be more intuitive, interoperable and will be available at lower cost than much of what is on the market today.
Again, thanks for writing. I have the upmost respect for my colleagues who are engaged in clinical practice.
I just meet a lady who live here for 25 years. Her husband died and she moved back to Malta. She has since returned to the US because the great system in and around Malta will not take B.C.B.C. She also stated it would take months for her to get the care she needed. So much for Europe's great system.
I think we need to take a look at what is good in health care in the US and use it to fix the problems.
Survivor of a heart attack
Emergency stint operation
Thanks for your comment, Joe. I didn't suggest that all of Europe does healthcare equally or equally well. You'll note that I also said the US excells in diagnostics and therapeutics for those who have access to the system. My post and comments were related to the adoption and use of health IT in America, where we do lag behind many countries in Europe.
Standardization of EMR systems will be crucial for universal acceptance. If my EMR can't talk to a referring physician's or a hospital's EMR, then we lose efficiency.
That was a good article.
I went to Korea recently and i was surprised about the level of technology they use for recording things about patients.
My girlfriend was wandering around a hospital but never got to carry any paper with her. She saw a few doctors during her day at the hospital and all accessed her file, pictures and other analyses on their computer
In order to really benefit from the use of information and communication technology in the healthcare industry, there should be worldwide standards. As we all know the integration of technology in the healthcare system should make the delivery of healthcare services more efficient. However, without well-defined or worldwide standards companies will create proprietary software based on a client’s needs. Once a client invest in customized software it becomes very difficult to migrate or convert to new standards.
Patients travel to other countries to have surgeries, sometimes it even happens while on a trip one can have an emergency and needs surgical procedure while abroad. With the use of technology, patients, doctors, insurance companies should be able to access medical history.
I will also mention that confidentiality and privacy will be a major issue however, there are other fields such as banking, airline, federal that are sharing information worldwide. So if there are worldwide standards that allow the services to be more accurate, easier and efficient in these fields.
The same can be possible in the healthcare system, as long as the government become more involved in the integration and implementation of technology in the healthcare industry. The world health organization should play an important role in the future of the healthcare system, even though every country might use different healthcare system.
I have recently read several articles concerning the topic of EMR systems in health care and the problems they can pose to individual practices. It would seem that regarding the greater idea of health care reform, in general in this country, this would be one of the first issues we would strive to correct.
I read another article http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107 in which it states that "The World Health Organization ranks the United States as having the 37th best health care system in the world..." This seems particularly low, however I would have to stem back to what Mario Vallias-Jean wrote and say that there really ought to be a worldwide standard for information and communication technology in the field.
As we move forward through this century we cannot afford to let health care systems, that are still fairly new, go without being adapted to provide efficient communication between providers, doctors, and facilities.