HHS takes steps to make EMRs less complicated to use

Experts say adoption of a standard clinical vocabulary is a good start.

By Tyler Chin, amednews staff. Aug. 4, 2003.

The U.S. Dept. of Health and Human Services has announced two initiatives to spur widespread adoption of electronic medical records, but major barriers to that goal remain, according to industry experts.

In July, HHS signed a five-year $32.4 million contract to license SNOMED CT, a clinical medical vocabulary owned by the College of American Pathologists. HHS plans to make the program available at no cost to users in the United States through the National Library of Medicine starting in January 2004.

The agency also commissioned the Institute of Medicine to design a standardized model of an EMR. Health Level Seven, a health care standards development organization, will evaluate the model, which HHS also plans to give away next year.

The SNOMED development is particularly significant because it helps remove one of the key barriers -- the lack of a standard clinical vocabulary -- that has deterred physicians from adopting electronic records, said J. Marc Overhage, MD, PhD, senior scientist with the Regenstrief Institute, a research organization active in medical informatics. It is affiliated with the Indiana University School of Medicine in Indianapolis.

However, the free availability of SNOMED alone will not accelerate physician adoption of EMRs because the average doctor still can't afford the infrastructure, software and hardware costs associated with them, said Dr. Overhage, an emergency physician.

There's also the cultural challenge involved in making the transition from paper to electronic records, said Nancy Brown, senior vice president of strategic planning at McKesson Information Solutions, a unit of McKesson Corp., which sells clinical software.

"It's not going to make it easier for people to buy and put systems in their office, but it's going to make the systems a lot more effective once they are installed," Brown said. "It doesn't mean that we'll wake up tomorrow and everything will be better, but it is one of those fundamental things that needed to be put in place [for the industry] to be able to move forward."

The integration of SNOMED into an EMR will benefit the average physician, but doctors won't rush out to buy EMRs because the benefits occur at the back end rather than the front end, Dr. Overhage said.

"My wife is a general pediatrician who could care less about information systems and computers and won't see any difference in her life for the next three years as a result of this," Dr. Overhage said. On the other hand, she and her peers will receive reports from different national and hospital laboratories that will look more alike. They also will be able to buy EMRs capable of receiving data electronically from those laboratories without having to re-enter data into their system.

Physicians also will receive quicker access to data that they will be able to use to take better care of their patients, said Thomas K. Houston, MD, an internist and director of health informatics unit of the Center for Outcomes, Effectiveness, Research and Education at University of Alabama-Birmingham.

That's because most doctors use different terms to describe the same diagnosis and every EMR on the market today represents those terms differently, making it impossible for doctors and institutions to aggregate, extract and analyze data in those systems. But if technology companies embed SNOMED in their EMRs, the systems automatically will SNOMED-encode those terms, which will make it easier for researchers to mine data to improve care and patient safety, as well as to conduct public health surveillance, Dr. Houston said.

For that to happen, EMRs must not only become more affordable but also better designed. "This is an important first step forward, but I think that getting systems that are usable to providers are an important second step," Dr. Houston said. "It's not just usability but also efficiency and integration within the flow of care ... that's one of the next challenges."