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road may well be fi lled with potholes for those less fortunate. Regardless of tactical decisions, what is clear for both Eimer and Gillespie is that the Obama-stated timescale is brief to say the least – but that doesn’t mean it isn’t feasible. “From a feasibility perspective, because they are throwing an infusion of cash into it, we’re probably going to get 60 to 70 percent there,” predicts Eimer. “The larger healthcare organizations, the ones that are already there, are going to see some consolidation within healthcare, so the smaller community hospitals that can’t afford to get into the electronic health record are, I believe, going to have to join some of the larger organizations. Ultimately, everyone in healthcare agrees with the spirit of it; it’s a little bit of an ugly baby, but I think we’ll easily get three-quarters of the way through it.” Where Eimer talks of the differences between big and small, Gillespie highlights the difference in system choice between the two. Ultimately, the vast contrast in options available between the two has led most to believe that smaller institutes will inevitably have to join the bigger fish if survival is of the essence, which is has to be. “The timeframe is brief given the fact that only 18 to 20 percent of physician offices have EMRs today,” reveals Gillespie. “There’s a large gap to be crossed in order to automate that many physician practices; at least three months to select a system and to negotiate a contract with a vendor and then probably another eight to 10 months to implement the system – and that’s just the technology. After that is installed, the physicians and their associates have to change their processes within the practice to adapt to the technology, which is the real bridge to meaningful use.”
process is a whole different view and I appreciated the fact that the nursing staff had computers on wheels and they were scanning my wristband, checking to make sure I was getting the right meds. I experienced the technology firsthand and I was thinking had I been in a hospital where the technology was not that up-to-date, I’d probably be a little more concerned. It made me realize that it’s not just about EMRs, it’s all the bedside technology that’s there; they’re both becoming interoperable and integrative. They have a true continuum of what the physician and nursing staff need when they see that patient’s history.”
Security Of course, the need to visibly show change within wards and throughout the environment of one’s hospital will change according to the culture inherent within, but the back-end work for any CIO or CTO will inevitably remain the same, whether that be implementation, optimization or getting to grips with meaningful use. Eimer cites the ongoing swapping of applications to simplify, consolidate or otherwise standardize, while Gillespie is looking towards computerized provider order entry (CPOE) as the “lynchpin to meaningful use”, with both ultimately looking to get one step closer to the currently elusive goal of complete and comprehensive ‘e-care’ – where EMRs, technology and the human touch combine for a fully streamlined process. But before that becomes anywhere close to a reality, security issues need to be pushed to the forefront of the EMR collective. “Security will be the biggest challenge moving forward for sure,” commits Eimer. “There is High Trust, an organization that companies are subscribing to, to at least get everyone on the same page with respect to security. There’s
“The larger healthcare organizations, the ones that are already there, are going to see some consolidation within healthcare, so the smaller community hospitals that can’t afford to get into the electronic health record are, I believe, going to have to join some of the larger organizations” The human element remains the other half of the battle to implementation, as both Eimer and Gillespie are well aware of, but for the patient, knowing that the hospital they are in has the most up-to-date technology is half of the point – as Gillespie has experienced first-hand. “I was a patient a few years ago and had serious surgery,” he continues. “Looking at it from the bedside, being a patient going through that
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a High Trust Alliance that we’re working on in the Dallas area to try to give physicians one set of credentials that can be used in multiple provider settings. Security will undoubtedly become the biggest challenge with moving towards monitoring patients in the home setting, especially with the emergence of telemedicine. How am I going to verify that I’m talking to the person I’m supposed to be talking to? Then you’ve got all the HIPAA and privacy regulations, so I think
security is going to be more of a challenge than implementing electronic healthcare.” Unfortunately, the truth of the matter is that while Eimer is right in every sense of the word, nobody really has an answer to the problem yet. Security has always been the least funded discipline in healthcare because it doesn’t provide revenue and it doesn’t deliver patient care, so why would anybody invest in it? As a generalization, healthcare organizations have under funded security and have done the bare minimum to pass the Joint Commission and HIPAA standards. As Eimer puts it, “HIPPA is getting more teeth into it and you’re starting to see other regulations get more teeth, so organizations are going to have to fund security more than they ever have, which is going to take away from electronic health records and the like.” As Eimer sees it, there will have to be a shift in attitudes – as he rightly says, you’re only as strong as your weakest link. If organizations don’t step up to security responsibilities, it’s definitely going to hurt in the long run. But security comes down to far more than securing information; in order to do so, you have to fi rst secure your communication links. Or, as Gillespie puts it: “Wireless, wireless, wireless”. “The challenge with wireless, particularly in some of the of the older facilities, is sustaining that connection, because you’ll have the access points located and the nursing staff will move their carts and netbooks and traverse across multiple access points, so you have to sustain that connectivity as they move. It’s not all about what’s happening at the bedside or in the physician practice, it’s also what’s happening on the back end, the data center. “Physicians don’t see that, but they do see it when it’s not working. When the wireless connection is down, their global device is broken, they see that – but they don’t see the entire infrastructure we’ve built: the servers, the storage, the networks and electronics. While we’re doing what I refer to as the ‘glitz and glamour’ at the bedside, we also have to be increasing the capacity of our data center. That back end of technology is extremely important.”
Digital literacy Th is idea of understanding the importance of, and maintaining a patience for, technology is part of a healthcare culture that is starting to emerge with the introduction of EMRs – not forgetting the accelerated world of consumer technology we find ourselves living in today. However, for all the good that technology does, there will be those from the baby-boomer gen-
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