Last weekend I was watching a show on TV about the failure of policy in the US to reform the school education system. Under the Bush administration and pre 911, an education bill was passed with strong bi-partisan support to improve the education level of children with respect to Reading, Writing and Arithmetic. Payment incentives to the states were tied to achieving certain pass levels for those subjects and the more children that passed, the more funding the state received. Sounds like a good policy and it should have driven success.
However there were two fundamental problems. No standard was set at the national level that the individual states had to achieve and the only two measures that were required under law were reading and arithmetic. What resulted was that the states, instead of raising the bar to require higher levels of performance actually reduced the standards for these two subjects so that more students could pass. In retrospect, this is understandable behavior as it increased the federal payments for education. However, it is now seen as a significant failure of policy at the national level.
Jump north of the border and consider what we have done with EMR policy in Canada over the past 10 years. Guidelines were established for EMR that made recommendations to the provinces for EMR functional requirements, however a national policy was never established to require all provinces to use the same messaging standards for EMR-to-EMR and for EMR-to-Other data exchange. In addition, policies were implemented piecemeal without establishing national goals for adoption resulting in some provinces moving ahead rapidly and others still without an EMR program in place 10 years later. Instead of one large EMR market in Canada and a healthy EMR industry, we have a fragmented market, vendors struggling to maintain certification levels in individual provinces at the expense of focusing on making their products better for end-users and key fundamental requirements for success still not in place - namely EMR-to-EMR messaging standards and ePrescribing.
Will we see growth in adoption and use of EMRs in light of these policies? I am convinced we will, particularly in provinces that have committed funding, bodies to support adoption and growing peer influence. Could we be more successful? Without a doubt. However, in my opinion it cannot happen without effective policy being developed at the national level which in turns drives and encourages the right outcomes at the provincial level.
In order to establish good national policy we require strong leadership with respect to EMR adoption and use, something that at this time does not exist. And that my friends and colleagues is the fundamental problem.
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