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On AHCJ fellowship to Denmark, a Politico reporter finds parallels to U.S. implementation of EHRs Date: 09/13/19

Arthur Allen

By Rebecca Vesely

Arthur Allen, a health care editor at Politico Pro, has covered health IT extensively and was a founding member of the eHealth reporting team formed at Politico in 2014.

Allen was one of four veteran journalists selected for the inaugural 2019 AHCJ International Health Study Fellowship. Supported by the Commonwealth Fund, the six-month fellowship allows veteran U.S.-based health care journalists to pursue a story or project comparing an aspect of the U.S. health system to another country.  Participants were allowed to study a developed European country.

Allen's first article to come out of the fellowship is “Lost in Translation: Epic goes to Denmark." The story is a comprehensive and often critical look at what happened when some Danish hospitals adopted Epic, the leading U.S. electronic health record system, which is headquartered in Wisconsin.

Allen spoke to AHCJ about the fellowship and his approach to the story. This Q&A is condensed for length and readability.

Q:  How did you get the idea to go to Denmark to look at EHR implementation?

My original idea was to report on how health IT adoption works in a single-payer system. When people talk about EHRs and interoperability in the U.S., they often talk about it in the context of it working best if there aren't competing incentives such as competition among hospitals and worries about losing customers by sharing information with competitors. I thought, let's test it out where there is a single-payer system.

I thought Denmark would be interesting because it has a sophisticated health system. Additionally, I lived in El Salvador for three years and I've found that when there is a problem you are trying to study, it's more manageable to draw a bead on a small country.

Q: How did the AHCJ International Health Study Fellowship support your work?

AHCJ and the Commonwealth Fund connected us with very smart people who work in the areas we chose to report on, during meetings in New York and London. I spent two weeks in Europe because I chose to do one story in Denmark and another one in the United Kingdom. [The second article, published after this interview, is an eye-opening look at health IT infrastructure failures in the British National Health Service. The story can be found here.]

Q: How did you connect with sources for your story?

One of the first people I contacted was a Danish IT consultant who connected me with Gert Galster, who ended up being the lead in the story. Gert had been involved in the Epic implementation from the start and had really thought about it. It turned out to be a good interview.

I conducted three or four interviews over Skype prior to going over to Copenhagen. While in Denmark, I made an effort to talk to as many different people as possible. They were packed days over one week of interviews. I talked to maybe 20 different people while I was there.

Q: In your article, a big theme is that culture is extremely important to tech adoption. You had some great examples of this. For instance, a nurse in Denmark typically can prescribe medicine and then explain it later. But in Epic, there is a “hard stop" prohibiting the prescription from going through when initiated by a nurse. What were some strategies you used to get these great anecdotes on a short interview timeframe?

To get interviews at hospitals, I mostly worked through the flaks (PR managers), and they were often trying to put a good spin on what was happening. But people were also pretty direct and honest. They seemed less beholden to some other authority than you would find in a big U.S. health system. They weren't afraid to insult Epic. They were all upfront with the problems and pretty open about sharing them with me.

Q: What were some parallels you found between the U.S. and Denmark in terms of clinician use of EHR systems?

The problems were typical of U.S. implementation but in spades. The burnout, the endless amount of typing, the data entry – they were all similar to what we've seen here. The Danes were even less used to this than Americans. Their hospitals have accountability but not the same pressures in terms of billing and extracting money out of each patient encounter.

Q: You tied Danish hospitals' experience implementing Epic to the Department of Veterans Affairs' current implementation of a new EHR. [The VA is switching from a homegrown EHR system to Cerner and will go live by 2028.] What do you think U.S. reporters should look out for as the VA transitions to a new EHR system?

The VA is, in some ways, a potentially fragile environment to be introducing difficult new workflow changes. It's important to talk to clinicians about how it goes and in a setting where they are honest and forthright and can tell us whether it is or is not serving veterans. It's not easy to get at the front line people dealing with the system.

Q: What most surprised you about reporting this story?

What most surprised me was how open people were to talking about their experience in honest ways. I didn't feel like I was getting B.S. from anyone. There are serious and devoted medical people in that country.

Q: How was your experience with the fellowship?

It was a wonderful, wonderful experience. AHCJ and Commonwealth Fund really provided useful support in terms of the money to do it and the people who they arranged to talk to us.

Q: Health IT isn't a topic that gets a lot of coverage in the mainstream media. What tips do you have for reporters who want to pitch a health IT story to their editor?

Health IT plays an important factor in physician burnout. There's all this aspiration to introduce new technology that can do all these wonderful things in health care – like machine learning and data analytics – but the whole system rests on clinicians. They are the interface with the machines and with the patient. It's important as journalists to pay attention when the people using this technology are complaining about it.

Applications for the 2020 AHCJ International Health Study Fellowships are being accepted through Oct. 7, 2019.