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Alan Pelz-Sharpe

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ECM: Transforming the US Healthcare System?

11-Aug-2009

Tags: , Document Management (ECM), E-mail Archiving and Management, Health Care

During a conversation with a journalist today about ECM and the US healthcare sector, we discussed why so little progress has been made toward electronic document and records management in the sector. There's been little progress despite the push from HIPAA (originally passed in 1996) and now billions of dollars of federal money flowing in to move things forward. My take is that things won't look much different 5 or 10 years from now, regardless of money, as the will to change just isn't strong enough. Also, the approach being taken is the wrong one.

Consider the following:

• Despite the labyrinthine complexity of the US healthcare system - somehow it "works" and has done for years, so why change?
• The healthcare system in the US consists of two equally complex meta processes - insurance/billing & patient care - so where to start?
• Standards and agreed procedures are not uniform across the United States: Federal, State, City and Local entities all have to have a say
• The healthcare system is so highly fragmented, that there is in fact no "system". Instead there is a loose amalgam of public and private entities all with vested interests, and interests that often conflict
• Patients have the temerity at times to live to beyond 90, change state residency, insurance companies, employers and sometimes go without coverage at all

I am only scratching the surface of issues above.... though the ECM sector is getting very excited indeed about billions of dollars coming available from Federal government to help with EHR (Electronic Health Records). The lessons from the UK's National Health Service suggest that though lots of money will undoubtably be spent, not that much will change.

For sure there will be some 'state of the art' hospitals using joined up and impressive ECM systems, just as there will be adventurous local clinics that will sport staff with tablet devices. But fundamentally paper records will be a mainstay of the US health system for many years to come, and will likely run alongside electronic records for decades.

My advice to the buyers within healthcare is to cautious of the snake oil salesman. Those who come to you with grand visions of unified information systems across regions should be treated with great caution. Those who offer transitional routes via the use of imaging and scanning systems, and who support and will work with you on simplified standards and processes, should be given a little more ear time.

Despite the Obama administration's efforts to move EHR along, I would wager that the targets being set will be missed time and again. $20 billion sounds like a lot of money, because it is a lot of money. But it will not fundamentally change the current situation, though it is enough money for a start. Like all ECM projects that go wrong, the focus is currently on EHR and the technology that supports EHR, when the focus should in fact be on the processes and process transformations that will need to be managed and changed across a wide array of conflicting and disparate working units.

EHR, just like ECM is a process of business change utilizing some underlying and supporting technologies. Any project that sees it the other way around is doomed from the start. I fear that is sadly what has already happened here.