Monday, July 6, 2009

International EHR Adoption

I was recently asked to compare EHR adoption in the US to other countries. Based on my own experience and the comments I received from colleagues, there are three aspects to consider:

* Use of Ambulatory EHR
* Use of Inpatient EHR
* Interoperability

Ambulatory
The most widely implemented are England, Denmark, Netherlands, and certain regions of Spain which are close to 100%. Sweden, Norway are at 80% and behind and Germany/France are at 50%. The US is somewhere between 2 and 20%, depending on how you classify a comprehensive EHR. Based on my definition - codified problem lists, e-prescribing, and decision support, the US is below 10% adoption.

Inpatient
Teaching institutions are generally well equipped, although less sophisticated on average than the US. Coverage in mid-low tier hospitals is high in England, Sweden, Norway, Denmark, and Finland, followed by Germany and Spain. In the US, CPOE adoption nationally is less than 25%

Interoperability
Denmark has the most signification implementation of production HIE with over 90% of encounters shared electronically. Certain regions in Spain, English, and Sweden have significant HIE. Canada Health Infoways has done excellent work with standards harmonization and incentivizing data exchange at the Province level. In the US, e-Prescribing is high is some states such as Massachusetts, Rhode Island and Nevada, but quite low in others. Clinical Summary exchange is done in some regions (Indiana, New York, Massachusetts, Tennessee, Minnesota, Arizona, Virginia) but most regions are just beginning implementation.

I've visited several sites in Sweden over the past 5 years, and the most innovative County is Jönköping

Qulturum is the organization in Jönköping that organizes the most innovative aspects of healthcare quality improvement including IT implementation.

As we think of lessons learned to guide US EHR installations, Scandinavia is definitely a region that has done IT right.

I welcome comments based on your own international experiences.

4 comments:

Israel said...

In Israel, all community based primary care clinics use EMRs, for about 75% of the population this is the same product (an Israeli product called Clicks).

In hospitals there is much less use, probably around 20% patients are cared for with the assistance of an EMR.

As for HIE - Clalit Health Services which insures approximately 55% of the population shares information across the organization using the dbMotion platform which is also used by ~60% of hospitals (by beds) in the country.

cbmd4u said...

Iceland has one of the most comprehensively implemented plans for an entire nation, but very
small and homogeneous. Finland has made very
early use of the first CDA and I have not kept up with
their progress in recent years. Don't know if the CCR
CCD controversy ever got there.
Puerto Rico had one of the first smart card implementations, but not sure that it lasted..
I should be able to report soon on the ease of interoperability between Mayo Clinic and Scrippshealth soon..

Chris Bickford MD Mayo/Healthvault Scripps/?

GreenLeaves said...

Patient safety is one of the main drivers of EHR adoption. In response to a blog I wrote about tracking of cumulative radiation exposure, Tibor Duliskovich commented:

US is well behind Europe in this respect. 15 years ago, working for an FDA-like government institution in Hungary, we were required to track population exposure to ionizing radiation, both man-made (medical exams, nuclear power plants, etc.) and natural (miners. pilots, radon) on individual and national level.

ShadIsland said...

Our research on Nairobi brought u some interesting topics around the avoidance of the "vendor lock" that has happened in the U.S. Some poor countries with dire needs, like Kenya, are relying on cell phone networks and open source ehr software to try to leapfrog the "vendor lock" issue that apparently has slowed progress in the U.S.