This reminds me of my earlier post here about another organization in California that spent that level of cash and had little to show for it except perhaps controversy. From that story:
Internal documents show the [UC Davis clinical IT] project -- with the final bill estimated to be anywhere from $75 million to $100 million -- is two years behind schedule and up to a fifth of the budget went to an outside consulting firm whose expense reports are now the subject of an internal UC audit.
Now we have this in Pennsylvania:
... [Lancaster General Hospital] plans to invest $60 million to $100 million in electronic medical records, another step toward transparency. Marion A. McGowan, executive vice president and chief operating officer of Lancaster General, said electronic medical records are a vital step toward giving patients more control over their care. Primary care physicians would be able to access the information during office visits, and the patients themselves can see their information from their home computers.
The other myth I keep seeing is how EMR's and PHR's ("personal health records") will "empower patients" and "give them control over their care." I've seen no evidence of that and do not understand the arguments behind this claim, but such statements do have "punch" and make a great marketing and "selling point" - which brings up another issue:
I am becoming increasingly concerned about whether the push for national-scale EMR's has created a "gold rush" where prospectors of varied honesty and ability have set out to 'strike it rich' -- by sucking every dollar they can out of an already strained healthcare system under pressure to 'revolutionize care' through computerization.
It seems like health IT is entering a a "pre-Flexner report medicine" or perhaps "Roaring 20's" phase. The UK's CfH national EMR initiative seems to be a few years closer to the "Great Depression" than ours; e.g., see "£20bn NHS computer system doomed to fail ". I am concerned we could be headed down the same path.
At the same time, I see schizophrenic articles such as this ("Hospitals oppose plan for uniform reporting") where the senior vice president for policy and regulatory services at the Hospital and Healthsystem Association of Pennsylvania, an organization representing hospitals, claims that "[computer reporting on hospital infections] is very costly", in fact too costly for small hospitals to implement for participation in a single statewide system.
As a physician from Philadelphia whose father died of a hospital-acquired infection, a medical informatics specialist, and a staunch advocate of clinical data initiatives to improve quality of care, I am highly troubled by such statements. Such a central state infection rate reporting system could be implemented, for example, by just a few competent IT people and accessed by hospitals via the Web on commodity PC's, transcribed from paper by hospitals if they have to. In fact the hardest part would be development of a standard, agreed-upon state dataset and data definitions, not technology costs.
Such technology is, in fact, dirt cheap in 2007.
I think it more likely that hospitals and their cost-cutting management fear what an integrated, consistent reporting system might make them do - clean up their dirt, literally.
Reducing infection rates is the expensive issue, requiring better facilities management, enforcement of handwashing, etc., but ultimately the benefits outweigh the financial and human costs by several orders of magnitude.
Hence, resistance to such simple technology as a central infection registry at a time when we can send megabytes of information around the world effortlessly in seconds, and when powerful PC's and web technology are commodities, is absurdist at best.
My concern here is that hospitals would rather make such claims to avoid participation rather than perform the truly expensive physical and process cleanups needed to reduce infections.
It costs little to do little. The ultimate economy in healthcare, after all, is death.
Health IT is an industry that has a bit of a split personality (sorry for all the metaphors today). I believe it needs far more transparency that it has, along with other healthcare sectors (nursing homes and pharma come to mind).
As provocative statement of the day, based on an ever growing number of anecdotes and case examples of health IT difficulties, failures, consultant overuse, etc., I am increasingly of the belief that (at least in public hospitals), strong community, external stakeholder, or other oversight is needed for health IT projects.
I increasingly do not believe most hospitals are competent, disciplined and well-managed enough to accomplish enterprise EMR implementation by themselves without large amounts of overspending, inefficiency, and waste (if not outright failure), and that outside oversight may be essential to ensure these tasks are performed in a manner that makes the best use of limited resources.