I recently flew into Charleston, S.C., to see how the Medical University of South Carolina was handling its electronic health record systems. I went Deep South because MUSC has had the Oacis medical record system in place since 1993 ? it was the first hospital system in the world to buy one.
I went there to check out the system because all the hospitals in Montreal, along with Sunnybrook Hospital in Toronto and the Children's Hospital of Eastern Ontario in Ottawa (not to mention almost the entire state of South Australia) either have or are about to use an Oacis system supplied by Canada's Telus Health Solutions.
I especially wanted to see the effectiveness of an EHR system after it had been used for 16 years in a locale that has a million patient visits a year.
At first glance, everything seemed somewhere between coolisimo and highly efficient.
Larry Afrin, who is both a hematologist and director of information technology for MUSC's Office of Graduate Medical Education, demonstrated how he could comb through 16 years' worth of medical records and uncover a previously unforeseen negative interaction between a standard antibiotic and the suppressed immune system of patients undergoing chemotherapy.
He then showed me, with a couple of keystrokes, how you can retrieve an electronic version of a chest X-ray, or indeed any image, at will. And finally, he gleefully described how the moment Oacis was put in place he had torn up stacks and stacks of the three-by-five-inch cards on which he previously wrote all his patients' medical particulars to refer to when visiting their bedsides.
Following the money
With these successes in mind, I began asking people at MUSC a very different kind of question. Had the purchase of electronic health records saved or made money for the hospital?
I asked first because cost-saving is the lure many EHR vendors claim or imply when selling their products.
Novarad Corp. of Utah, for example, crows on its website about one of its products: "Because it takes care of all of your information and imaging needs, you'll start saving tons of money before you even plug it in." It then directs purchasers towards an online return-on-investment calculator to figure out their future savings.
Companies are not alone in seeing the EHR systems turning into operational gold for hospitals and clinics.
Canada Health Infoway, the federally funded agency partnering with provinces and territories to create a cross-country electronic health record system, commissioned a private consulting firm to monetize the values of computerized health imaging ? what is known as PACS, or picture archiving and communication systems.
Their estimate [http://www2.infoway-inforoute.ca/documents/chi%20diagnostic%20imaging%20report_engreport.pdf]: It could save our medical system up to $1 billion a year in existing or projected expenses.
Another study CHI quotes says EHRs could save the country as a whole $6 billion to $7 billion. In the U.S., Rand Corp. estimated in 2005 [http://content.healthaffairs.org/cgi/content/full/24/5/1103] that a digitized American medical system could save that country $81 billion annually.
But what is happening on the ground in South Carolina is a lot less convincing.
After 16 years of experience with electronic health records, and after spending $23 million a year on its clinical computer systems, MUSC still doesn't know if it is saving or making money.
"We have some studies underway to document ROI ? that is, the return on our investment ? but at this stage we feel we can't say it has been positive," says Frank Clark, chief information officer for the MUSC.
What about all those money-saving claims from companies?
"Vapourware," Clark says in his soft southern accent.
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