The debate on adequate healthcare coverage is commonplace in these days. But what about the internal struggle that the healthcare system faces if such universal and affordable healthcare were available?

A recent poll by Picis (Wakefield, Massachusetts) of more than 300 physicians, nurses and hospital administrators shows some of the large cracks that have formed in within the barrier of healthcare system, and if these openings aren't repaired, then the system (even with universal coverage) risks implosion.

Two of the top challenges that the system faces are physician and nurse recruiting retention and the absence of a cohesive set of electronic health records (EHRs).

Personnel retention ranks as the highest concern from poll participants.

The U.S. is currently facing a shortage of 400,000 nurses and, as cited in a 2006 report, "Physician Supply and Demand: Projections to 2020," the U.S. Health Resources and Services Administration projected a shortfall of 55,100 physicians by 2020.

When the question "What is the primary way your acute-care system can help staff recruiting or retention?" was asked, nearly 47% said they believed the goal could be accomplished by redirecting staff time so more time can be spent on patients than on administrative tasks.

Nearly 36% stated that efforts could be made to improve job satisfaction and 17% said the way to keep staff retention was through better communication between the patients and staff.

A May survey by physician recruiting firm also indicated that nearly 20% of physicians would leave the field with the potential implementation of universal health coverage.

"Today's caregivers are under intense pressure and are forced to do even more – more regulations, more paperwork, more direct patient care – but without the manpower to support it," said Lorna Prutzman, a 20-year veteran registered nurse and director of emergency/stroke services at University of Colorado Hospital (Denver). "These poll results emphasize the critical need for hospital systems that will improve quality of work life for both physicians and nurses."

The survey showed that the rollout of electronic health records ranked as the second-biggest concern and additional questions were raised about how the role of government-funded EHR initiatives and the joint ventures from companies such as Google (Mountain View California) and Microsoft (Redmond, Washington) will affect the future of hospital technology systems.

Nearly 90% of poll respondents believe that EHRs are going to revolutionize the healthcare system, but the majority predicts it will be at least 10 years before EHRs are used in the majority of U.S. hospitals. Additionally, only 55% said that patients would be more likely to visit a hospital using an EHR system, vs. one that used paper systems. Close to 90% said government-run EHRs are the answer, but many expressed interest in joint funding from the private and public sectors.

"I guess the biggest question becomes, 'Do you use government-funded EHRs or private EHRs?'," Justin Chang, an emergency physician with Kaiser Permanente (Oakland, California), told Medical Device Daily. "My answer is, you do whatever it takes, but the key is for every agency to truly believe the medical record belongs to the patient and not to themselves."

The result of not having EHRs on a widespread basis leads to many problems, Chang said. "You're dealing with double documentation, you're duplicating efforts, there are problems with accuracy of doses – it's just a process fraught with error," he told MDD. "Look how many times in a patient's life do you have to see if they have a serious allergic reaction to medicine. The answer is never more than once."

Chang added that if EHRs were to become widespread, that could eliminate a lot of the administrative tasks and would give patients more time with their physicians. He said EHRs would be more cost-efficient.

"I think anybody that works in modern medicine knows there is no more money to be found in healthcare," he said. "We need to be more efficient with the resources we have and free up money that way. It's going to be a real challenge, but EHRs are inevitable."

The live poll was conducted by Picis on June 15-18 at its annual Picis Exchange customer conference in Palm Beach, Florida. Some 325 attendees who are employed as physicians, nurses, IT technicians or hospital administrators in hospitals and health centers across North America took part in the poll.

"Working closely with the people who serve on the 'front lines' of healthcare today – from ED physicians to operating room (OR) nurses to hospital CIOs and business managers – has afforded us tremendous insight into the challenges they face, and we took this opportunity to further probe into the issues that are really keeping these folks awake at night," said Todd Cozzens, CEO/vice chairman of Picis.

Picis is a provider of information solutions that enable rapid and sustained delivery of clinical, financial and operational results in acute-care areas of the hospital.

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