TECHNOLOGY: The UK’s EMR project is not apples to apples, with UPDATE

As we go into this most uniquely American holiday, here’s a story or two about the place the pilgrims were thankful to get away from. Of course my British friends tell me that Thanksgiving is really on July 4th for them.

First up is CapGemini’s John Quinn (a Brit) writing about why the national health infrastructure initiatives in the UK and the USA are very different. He correctly points out that the UK is some 3-4 years ahead in its process, and that it is basing its infrastructure on a largely government run health system. He also points out that the financial commitment from the government there is huge — adjusted for population it’s the equivalent of $140bn over 10 years here. Adjusted for proportion of GDP spent on health care per head, the UK’s number is closer to the equivalent of $400bn over 10 years. Here, despite all the rhetoric the funding for Brailer’s office was just cut in yesterday’s spending bill, and he’ll be living on handouts for the next little while. Of course private sector players here are spending real money, and even $40bn a year is less than 3% of total health spending. So it’s almost certain that we’ll spend more than that number on IT here.

But it’s what Quinn doesn’t point out that may be even more crucial, as it relates to what we’ll be spending that money on. In his talk last week Brailer noted that the US has two challenges. First getting physicians to use the EMR, and then getting all those EMR’s to talk to each other. The Brits are focusing on the second part of that, the inter-operability piece. By the late 1990s they’d basically already done the EMR piece, albeit in a rudimentary way and mostly outpatient only. The average GP practice in any small British town vastly out-does the EMR-use anywhere in the US, apart from a few notable exceptions. So the Brits are starting from a position of strength in EMR uptake (at some 80% penetration), while the US needs to catch up. And of course the inter-operabilty piece is an imposing (or impossible) challenge here, where there are no incentives for the competitors in a marketplace to cooperate, and no government mandate telling them to, even (as Kaiser’s Robert Pearl pointed out) if it would be good for the health of the community and nation.

Meanwhile I’m sure my British surgeon father wishes this had happened to him; the BBC reports that a hospital in Winchester, Hampshire (which is incidentally where I went to high school) overpaid its doctors by 290,000 GBP and wants its money back

UPDATE: Matt Quinn notes that interoperability could be done, and that there is a private sector model for it–well sort of:

While it’s a vast oversimplification from the cultural adoption standpoint, the technology to implement and interconnect clinical systems across the nation is not too different from the technology that connects all of Wal-Mart’s point of sale and logistics management systems across the country such that anyone in a Wal-Mart store has nearly real time access to critical alerts and supply information and the HQ in Bentonville can monitor and research the whole network.

Of course, a key difference is that Wal-Mart centrally funded such a system and it appears that the federal government will not.  It’s not as if — given the choice — each Wal-Mart store would have funded, implemented and connected it’s own system without central funding.

Oh yeah, and Wal-Mart employees cooperate a lot more than physicians do (i.e. can’t refuse to use the system).

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