My criticism last week of hospitals’  failure to embrace electronic medical records (EMR) was somewhat tongue-in-cheek given the number of political barriers that I know exist relative to the topic. Yet, it is completely true that health care institutions, in Canada and otherwise, have not put in place adequate systems for sharing medical information electronically. This failure to enhance care through the use of EMR is mind-boggling given our pervasive use of digital communication in virtually all other areas.

Unable to pinpoint all the barriers to widespread adoption of EMR, I got in touch with Dr. Nadine Gebara, Resident, currently at University of Toronto. I asked her why our health care institutions have been so slow in digitizing their info - something libraries started doing almost 20-years ago. I quickly learned that the barriers to EMR are greater and more deeply engrained than I had imagined.

Initially, I suspected that resistance on the part of physicians had something to do with hospitals’ slow move to EMR, but Dr. Gebara’s experience suggested otherwise: “I have seen very little resistance on the part of health care workers. There’s actually some frustration among physicians about not having adequate EMR systems. Overall, attitudes towards electronic records are overwhelmingly positive given the clear benefits to efficiency and ease of access to critical information.”

While EMR promises clear long-term benefits to efficiency and quality of care, government is reluctant to spend on the technology. The investment in EMR is seemingly a no-brainer. Sure, it’s expensive in the short-term, but soon enough we’ll see increased efficiency, more care to more people, and health care providers happy not to have to sift through piles of paper records to find critical information.

The “no-brainer” status I assigned to an investment in EMR was challenged as I continued to explore the issue with Dr. Gebara.

“There are a handful of companies offering EMR products and platforms [like this one and this one, or just look here for a comprehensive list]. Hospital A, for example, might use one platform, but Hospital B down the street uses a different one. It’s great that they are using EMR, but the problem we run into is that you generally cannot share data between the two systems,” she said. 

The fact that different platforms cannot be integrated creates uncertainty around what the outcome and ROI of any wide-scale (and expensive) EMR initiative might be. Inability to clearly estimate and articulate the benefits of EMR hampers efforts to secure government funding. And, quite simply, ”lack of funding is the greatest barrier to universal EMR.”

One (partial) solution would be for government and health institutions to select a single platform so that data can be shared in any hospital in any region.  But, if the government selects one service provider, do they not create an illegal monopoly in the industry?

Without government intervention, leaders in EMR technology will just have to emerge over time. With fewer players in the field and more hospitals adopting the same platforms, scalability and the ability to share data between hospitals will increase. In turn, the case for EMR funding will strengthen. Unfortunately, this implies simply waiting for the fittest platform to emerge. If that’s the case, then we shouldn’t hold our breath waiting for universal EMR. 

Adoption of Wikinomics principles on the part of the health informatics industry (referring to companies building and providing EMR platforms and services), however, would speed the journey to easily integrateable platforms. My guess is that the first company from within the EMR space who breaks down silos and produces a platform that integrates with others will be dominating the field when EMR arrives in full force – sooner, rather than later.