Boosting usage levels and turning promised benefits into reality

Points of view | 14 Mar 2012
Points of view of David Champeaux, associate director at McKinsey, and co-manager of the global healthcare technology sector.

International experience in rolling out and adopting electronic health record systems, such as the DMP, on a national level shows the need for active management over a period of several years, measures to boost usage levels and co-ordinated participation of all those involved.

A major challenge...

International experience, for example in the United States, has shown that adoption and use of electronic health records as part of new professional practices provides considerable benefits for all in the healthcare system, not only in terms of care quality, access to care and information, and the efficiency of the healthcare system, but also in terms of healthcare professionals' working conditions. The programme set up by Kaiser Permanente in Hawaii to improve management of patients with chronic renal failure is a good example of this.


... which requires change over a long period

One of the main lessons drawn from this experience is that if the benefits are to be seen, there must be co-ordinated involvement of many parties in the healthcare system in the use of the electronic health record as part of a new set of professional practices. The programme for implementing one such record in Australia recorded the scenarios in which practices would be changed using electronic health records, and which were most likely to generate benefits, and identified the participants needed to implement these changes.

The transition to using an electronic health record by the majority in the healthcare system is achieved gradually; it generally takes five to ten years to reach 50% participation among patients, general practitioners and healthcare facilities, as shown by experiences in Canada and Denmark.


... and in which use of the new system must be actively stimulated, supported and guided

Usage levels initially need to be stimulated, by identifying realistically achievable short-term usage levels and by providing prioritised support for those who contribute to the electronic health record, by using information on these types of usage (e.g. admission summaries or laboratory test results) or by developing usage based on information that can rapidly be made available on a wide scale.

For example, in Australia, proposed legislation governing the PCEHR (Personally Controlled Electronic Health Record) allows for the possibility of patients granting consent for some information (for example history of reimbursements or vaccination) that is held by Medicare (the public health insurance provider) to be copied into their electronic health records.

Development of usage levels can also be co-ordinated within healthcare communities, either on a regional level or in individual healthcare networks. For example, in Scotland, an emergency medicine programme has co-ordinated information sharing about patients' allergies and drug prescriptions between hospital emergency departments and community healthcare facilities.


... by healthcare professionals and those in the industry

International experience has shown that rather than concentrating on rolling out a technology, it is essential to adopt an approach that focuses on stimulating demand from those involved, by encouraging and supporting healthcare professionals and patients in taking ownership of new practices and customs using the electronic health record, and by adapting the technical platform to the functions that users are asking for. Recent surveys(1) of specialist and community doctors in Australia have shown that a significant proportion of healthcare professionals consider themselves to be pioneers of e-health, and that the main factor that influences levels of adoption is the opportunity to take part in the design and rollout of features.

Similarly, rather than defining and developing all solutions centrally, adoption and development of features can be accelerated by encouraging and supporting innovation in industry with solutions designed to supplement and add value to the main elements of the electronic health record, based on a common core of openly-available services. For example, in Australia, one of the sites that was piloting rollout of the PCEHR programme, designed and tested a solution for synchronising an electronic health card with the electronic health record.

About...

McKinsey is a global strategic consulting firm, which carries out around 800 projects per year in the field of health, and which works with numerous ministries of health, regulatory bodies, health insurers and hospitals throughout the world (including France, the UK, Germany, Scandinavia, the United States, Canada, Italy, Singapore and Australia).
Extract from the ASIP Santé's Annual Report 2011.