It’s settled. Electronic medical records and health information exchange are going to dramatically lower health spending, greatly improve the quality of care and save the world. Except that the research usually doesn’t find this to be the case. One reason is that implementing health information technology is expensive and complex. Government providers of health care and health care coverage have been mucking around in this area for decades, with decidedly mixed results. The Government Accounting Office examined the Department of Defense’s project to implement an EHR, finding not all was well, or as GAO puts it “Opportunities Exist to Improve Management”. (GAO Report) DOD provides health care to about 9.6 million people at a cost of about $50 billion a year, so it is important to get this right.
If you wonder why some people are concerned about too much government involvement in health care, listen to the following description of this project. It began in 1997 and was to consist of seven software releases starting in April 1999 and ending in June 2006 at a cost of $4.3 billion (1998 dollars). The functionality was to be as full and robust as you could ask for in an EHR and the data in the system was to be instantly available anywhere in the world that DOD was delivering care. Over the next few years the DOD constantly pushed out even the initial delivery data and reduced the functionality of the system. Some functionality was delivered beginning in 2006 but it is clear that it has such substantial performance issues as to almost be dangerous to use. There is a fair amount of downtime, the response time is slow and it doesn’t do what users need it to. It undoubtedly causes provider inefficiency and probably jeopardizes patient care if relied upon. Now DOD wants to start over with a project it calls EHR Way Ahead. Why not stop while you are EHR Way Behind. The GAO points out the obvious–this project had pathetic planning and management from the start up until today and it is not clear the successor project is going to be done any better.
It is clear that DOD basically took multiples of the originally projected time to deliver a system has no dependable functionality, and a far more limited functionality than originally described at that. While DOD’s response to the report was to agree with the recommendations, it also took exception to what it described as inaccurate, misleading and subjective statements in the report. Hey, you just wasted a ton of taxpayer money on a system that for all practical purposes doesn’t work and you are about to do the same thing all over again. How about you fire everyone involved, including the outside contractors, and start over. There is a lesson here for private health care organizations as they implement EHRs and other HIT. Assume the worst case in cost, time and disruption. Plan for how to mitigate that worst case. You can’t devote enough time and resources to getting this right. The quality of patient care is ultimately at risk.