Australian healthcare is learning from the mistakes of the US, with clinicians here leading the digital transformation of the health system rather than being “screwed” by politicians, according to Elsevier Clinical Solution’s Chief Medical Officer.
Dr Peter Edelstein – who has also distinguished himself as a cancer surgeon, healthcare executive, medical start-up entrepreneur and educator — also said change was inevitable and clinicians who resisted it should be urged to retire early, with hospital administrators advised to hold their nerve.
During his recent trip to Australia, Edelstein spoke to Healthcare IT News about the herculean task of implementing electronic health records and his “cautious optimism” at this nation’s clinician-engaged approach.
It’s an approach vastly different to that taken during the rapid uptake of EHRs in the US.
“In the States we are only now, years later, starting to say, ‘Hey, we should have some say in this’,” Edelstein said.
“In the end we put our heads up and we were screwed because none of the clinicians had stepped forward to be involved and so politicians just made policy.”
Then-US President Barack Obama’s HITECH Act of 2009 was designed to promote the take-up of electronic record use in US healthcare, but Edelstein said its timelines and penalties have caused hospitals to close down and others to lose millions of dollars.
“Hospitals and healthcare systems frequently went out and just said: ‘We've got to check the box, buy any EHR from them. OK, we have to have patient engagement, buy from there’,” he said.
“No one was able to take a breath and say let's spend the next two months talking about our mid-range and long-term goals with spending this money and given that let's try to have interoperability, let's try to limit the number of vendors and let's see which of these solutions meet our needs.
“I had an affiliation with a large hospital system that bought one huge EHR right out of the way because the government said you’ve got to do this and less than six years later abandoned it for another one, wasting two hundred million dollars.”
Upgrading from the EHRs implemented in that rushed first wave is now prevalent, Edelstein claimed.
“I've heard this more than once that this year in the United States more than half of all the EHR purchases are to replace EHR systems already in the hospital system.”
Another hospital system Edelstein was associated with received $20 million in penalties in the first year after the Act’s introduction.
“People don’t understand, the hospital industry is in real trouble because of the penalties.”
Compared to the scramble witnessed in the US, Australia’s more consultative approach to healthcare IT reform, including the path taken by the Federal Government with the National E-Health Transition Authority and the Australian Digital Health Agency, is the more rational, he said.
“We put the cart before the horse: ‘Buy, buy, buy! Wait, why are we buying?’ You guys have tremendous public discussion – NEHTA and now the ADHA represent the move forward.
“There are grand discussions at the hospital level here, at the state level and the federal level, so I think you've already learned probably the most important thing, which is: Before we take action let's have a long period of time where everybody from patients to hospital administrators to nurses to politicians are discussing this.”
He said while critics have accused the Australian Government of wasting money on the years’ long process, it will pay off in the long run.
“I think you've saved yourself an enormous amount of time, headache and money by allowing a very long open period of strategy and discussion so I think you've learned a lot already.”
With the increasing uptake of EHRs, Edelstein said hospital administrators required fortitude to contend with pushback from those resistant to the inevitable.
“It is going to be critical that you don't give physicians like me any wiggle room. The hospital that puts in any EHR and then the doctors complain and bitch and moan so the hospital says, ‘Well, you don't have to use it,’ you lose it.
He said doctors can be particularly critical of EHRs “because we don't like change”, and age can be a factor too.
“It’s just our generation this is a very painful change for.”
The champion of Elsevier, which is working to expand the integration of its online medical reference and patient engagement systems into healthcare, said digital disruption is essential to contemporary practice.
“The clinician should be involved but the non-clinicians must stay the course and there's going to be a lot of pushback: “Oh this sucks, my EHR is no good, it should have been an opt-in’.
“There are always going to be people who have legitimate and not legitimate objections, and the answer has to be: ‘Listen, this is where healthcare is going to help our population. I'm sorry it's disruptive, we’re going to help you any way possible, you’re welcome to retire early, you're welcome to try to find another system, but this is how healthcare is practiced now’.”
Meanwhile, in the US, despite the inside running, healthcare needs to recover from the heady days of EHR adoption and take a different approach. It will then get to where Australia is now, Edelstein said.
“I am cautiously very optimistic about how things are headed here and it will take a bunch of iterations but you are in a much better place early than we were and we're just starting to dig out. We will be okay too but we will waste a huge amount of money and time to get to where you already are.”