Prognosis Uncertain For Health Record Plan

With $19B Set Aside To Digitize Medical Documents, Anxiety High Over Its Implementation

(AP)  Here's the best-case scenario for the government's plans to spend $19 billion on computerized medical records: seamless communication among doctors and patients, and far fewer mistakes.

And the worst-case: $19 billion goes down the drain.

The medical industry is hoping for the first outcome, even while some fear the second, as the Health and Human Services Department tries to get hundreds of thousands of doctors to quit using paper files and join the digital age.

The money for the massive undertaking is in the economic stimulus bill that President Barack Obama signed into law last month.

"We need to get this right," said Dr. David Kibbe, a senior adviser at the American Academy of Family Physicians. "Adoption of information technology for its own sake really is not the end game."

The end game, Kibbe and others say, is for doctors' offices and hospitals to be able to easily share patient information, something the vast majority can't do today. That would cut down on mistaken and unnecessary procedures and give doctors faster access to more accurate information about patients' medical histories and drug regimens.

The government's history of undertaking major technological upgrades isn't entirely encouraging.

The FBI spent four years and $170 million trying to modernize its paper-based case system, only to kill the project in 2005. Before that, the Federal Aviation Administration wasted more than $1 billion trying to overhaul the air traffic control system.

For advocates of the health technology transformation, the biggest fear is that the money could pay just for making paper records electronic, without giving doctors and hospitals much greater ability to connect.

"It's not going to improve the decisions that either providers of care or patients make unless we get that information to move from the existing stovepipes," said Zoe Baird, president of the Markle Foundation, which works to improve health care and national security.

The U.S. lags behind many other countries in adoption of electronic health records. A report in the New England Journal of Medicine, based on surveys from 2007 and 2008, found that 4 percent of physicians had extensive, fully functional electronic records systems, while 13 percent had more basic systems.

Typically, many systems aren't connected to other physicians or hospitals. Dozens of vendors compete to sell proprietary systems that often cannot communicate with each other. Installation costs are prohibitively expensive for some doctors, particularly those in small practices.

Lawmakers and the Obama administration say they are aware of those problems and tried to write the stimulus legislation to address them. The bill envisions new standards to drive development of systems that are better able to communicate, and requires doctors and hospitals to show they're going to be able to put those systems to "meaningful use."

Computerizing records will "save money, improve the quality of care for patients and make our health care system more efficient," HHS spokesman Nick Papas said. "We will move quickly and carefully to help implement this technology."

But important details are missing from the legislation. A health secretary is not yet on the job, and other important officials are not in place. Just on Friday, the administration named the official who will serve as national coordinator for health information technology - Dr. David Blumenthal, a former Harvard Medical School professor who advised Obama during the presidential campaign and once worked for Sen. Ted Kennedy, D-Mass. Kennedy is chairman of the Senate Health, Education, Labor and Pensions Committee.

The stimulus bill specifies that $17 billion is to be spent in incentives through Medicare and Medicaid to nudge doctors and hospitals toward electronic record-keeping beginning in 2011. In 2015, financial penalties will start for doctors and hospitals if they haven't done so.

What systems will be deemed acceptable? How will doctors and hospitals be able to show they will put such systems to meaningful use? Those questions remain largely unanswered.

Preliminary technological standards are due at the end of this year. That doesn't give doctors, hospitals or technology companies much time to get systems up and running by 2011.

The bill also contains $2 billion for items such as health technology grants, training initiatives and state programs. The uncertainty surrounding this money has touched off heavy lobbying from interest groups hoping for a piece.

"The devils are in the details and we don't know the details," said Janet Marchibroda, head of the eHealth Initiative, a nonprofit that advocates for health improvements through technology.

Still, many health care professionals are optimistic about the prospects for a more connected health care system ahead.

"It will take time to get there," said Tom Romeo, IBM's vice president for government health care. "But everything's in place to really make a huge jump forward now like it never has been before."

[stormdreamer]

Has anyone mentioned the dreadful possibilities of the big insurance companies involvement in the e-medicene arena?
If I'm correct, it was Insurance Companies who first voiced the e-medicene concept to decrease thier overhead costs.
I've been watching this idea for awhile now, and it has good merit. But I feel it is NOT consumer driven but Insurance business driven. If this is the case, let me out at the next stop. I believe the Insurance Companies have too much control over our health care as it is, and people are dying because of it.

[quiact]

EMRs are treatment platforms that allow significant patient variables to be integrated into their care to assure the treatment they receive is reasonable and necessary, presuming the data is accurate. Present medical records on documents are digitized and integrated into the EMR.

In addition to EMRs containing the patient's progressive medical history, the patient's safety and combersomeness that occurs at times, such as repeat diagnostic testing, or medical errors of varying degrees, will be reduced. For the health care provider, the need for transcription of patient notes is eliminated.

With some debate, there will be increased profits for both health care providers and medical institutions due to EMRs offering the most diagnostic and procedural codes allowable for a particular patient. These codes are used to seek reimbursement from health care payers.

The continuity of patient care improves the care of patients and reduces the need of additional patient care staff, which at times is inadequate due to shortages of such needed professionals.

Evidence-based medicine and patient-centered healthcare are now possible and improved by EMRs. The benefits perceived by EMRs has resulted in various managed care companie to actually pay health care providers to adopt EMRs in thier practice.

However, health care providers who are in solo practice are understandably reluctant to acquire an EMR due to cost.

4 primary functions of EMRs include electronic prescribing, which is more efficacious in reducing prescription errors that cause over 5 thousand deaths a year. Electronic prescribing also lets the health care provider know if there is a generic version of the drug available, and if the patients pharmacy insurance benefit covers the drug chosen by the health care provider.

Also, ordering diagnostic tests, and retaining the results of these tests, documentation from the doctor about their patient after a visit, and thankfully improve data availability for health care profesionals to retrieve regarding their patients.

Additional patient benefits because of EMRs and patient care is that, in some studies, mortality of patients has been decreased between 35 and 45 percent. Also, those patients with chronic disease, which takes up 80 percent of health care spending, becomes more efficient due to the benefits of improving treatment for such patients.

Eighty percent of patients surveyed favor EMRs more than they do a health care provider visit. Presently, those who have access to EMRs range in ages of those in their late teens, to those in their early 90s, so the EMRs are user friendly. Users have the ability to advance their medical knowledge. This may likely improve their health and their medical issues by acquiring this knowledge,

Dan Abshear

[brainteaser2]

EHR is a wonderful idea that has been needed for years. However, there are no systems available that are capable of seamlessly communicating with one another. This defeats the purpose of the whole EHR. There is going to have to be cooperation between all vendors to make this system work. The idea is great but perhaps the ground work needs to be laid out before we start pouring money into the system.

[rational_1]

This just may have a chance of working - unless of course Microsoft excretes the bloatware that they use to implement this information sharing. In that case, just give the $19B to GM instead and let them waste it.

[jsf14]

Over the years I've seen many mistakes made by clinics and hospitals, I've seen money wasted. Electronic records might have helped in maybe two or three of these instances -- but even for these only if the information got entered correctly and the health-care professionals read carefully and paid attention.The chain of clinics where I get my health care has electronic records now. It's convenient for me but in two instances the clerk or nursing assistant misunderstood what was on the screen. Nevertheless it'd be interesting to hear whether these clinics think they've been saving money since the elctronic system went in.