Panacea or pandemonium?
by Bill Norman
An ambitious proposal from the Obama Administration seeks to provide an electronic health record (EHR) for all Americans by 2014. It’s a proposal with far-reaching implications for anyone who receives professional health care, and it has both supporters and detractors.
The American Reinvestment and Recovery Act of 2009 (the “economic stimulus plan”) that became law in February contains a section called the Health Information Technology for Economic and Clinical Health Act, or HITECH Act. It makes available more than $17 billion in financial incentives for physicians and hospitals to adopt and use EHR.
The goal of HITECH is to both save costs and create a continuum of health care data for all patients representing a lifelong record, updated as needed by a wide range of people and organizations.
Although central to the health care debate, EHRs are neither well developed nor well understood. An Arizona State University poll taken in June 2009 found that 15 percent of responders said they had heard “a lot” about EHRs; 49 percent had heard “some” or “only a little”; and 36 percent said they’d heard “nothing at all.”
Here then is Quest’s attempt to shed a little more light on the subject.
What’s an EHR?
Electronic health record, or EHR, is an all-encompassing term that refers to all types of medical records, but also connotes the electronic sharing of medical information among patients, health care providers and payers (i.e., insurance or government agencies).
- EMRs (electronic medical records) fall under the EHR umbrella. These legal records are used by physicians to document all patient information, such as test results, treatments, medications.
- PHRs (personal health records) also are EHRs. These are electronic records created by and accessible to the patients themselves. Data storage systems like Google Health and Microsoft’s HealthVault allow patients to create PHRs and make them available to doctors and others they approve. But the PHR systems don’t “talk” to each other or other comparable data storage programs such as RevolutionHealth or WebMD.
Both Microsoft and Google have recently formed partnerships with large health care providers like Kaiser Permanente and Mayo Clinic to determine if those providers could begin automatically transmitting patient data into PHRs for the patients they serve. |
The Big Problem: A Failure to Communicate
All but a few EHR systems now in use across the country are stand-alone systems. They may link multiple hospitals and physicians within a parent organization, but can’t communicate with systems of other care providers.
Cathy Lomen-Hoerth, director of the MDA/ALS clinic at UCSF Medical Center in San Francisco, said her clinic uses five different electronic records systems and “none of them can talk to each other.” She has one system for dictation with voice input, another for dictation entered on a keyboard, one for inpatient records, one for outpatient records (in old MS-DOS format) and one that is her personal database for use in the clinic.
Joe Hornyak, co-director of the MDA Clinic at the University of Michigan, said the clinic has had inpatient and outpatient records computerized for several years. “It really is a wonderful system to have access to UM providers’ notes at my fingertips … but it’s frustrating not having this access to outside providers’ records, as we are never quite sure what is going on.”
Katalin Scherer, MDA/ALS center director in Tucson, Ariz., said those who believe a nationwide EHR system is workable are “operating under a huge misconception.” Scherer said her clinic, which is affiliated with University Physicians Healthcare, has had an in-house EHR system in place for three years.
“We use a system supplied by Allscripts, as do several other care provider networks in Tucson, but even though the software is the same, our systems can’t communicate with each other,” she said. “That’s partly due to government-mandated protections of patient data that are built into the software. They protect information, but they prevent communication.”
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ELECTRONIC HEALTH RECORDS
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- EHRs may save money in administrative costs, which currently account for 31 percent of health care costs.
- EHRs may reduce medical errors and unnecessary tests.
- EHRs are more durable and portable than paper records. Joaquin Wong, co-director of the MDA Clinic at Children’s Hospital in New Orleans, knew a doctor who lost all his patients’ records under 10 feet of water after Hurricane Katrina. Many children had to receive a second set of immunizations in order to enter school.
- People think EHRs will help improve medical care. A poll conducted by the Harvard School of Public Health, the Kaiser Family Foundation and National Public Radio, with results released in April, found that 72 percent of survey respondents felt their own doctors could coordinate their work better if records were computerized; 53 percent said the number of medical errors would be reduced; 58 percent said fewer patients would receive unnecessary medical care; and 67 percent indicated the overall level of care would be improved nationwide.
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- An EHR system costs a lot to implement. “[P]hysicians will pay much more than the incentives facilitate, and it will take up to 10 years for most of us to recover these additional costs, if ever.” — Douglas W. Jackson, physician and medical editor of Orthopedics Today, in a May 2009 article.
- Even after spending a lot of money, EHRs still may not work as well as hoped, critics say.
- EHRs can be hacked. Millions of patients already have had their medical records stolen from computer systems. Recent victims include Virginia’s state prescription drug database and 160,000 students at the University of California, Berkeley.
- Unwanted people may have access to EHRs. Congressman Ron Paul (R-Texas), a longtime physician, introduced the Protect Patients and Physicians’ Privacy Act out of fear that government officials and state-favored interests will be able to view private medical records without patient consent.
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- In April, Business Week recognized SSM St. Joseph West in Lake St. Louis, Mo., as among the most “completely wired” hospitals in the country for its use of paperless records.
- Eastern Maine Medical Center spent $35 million over 15 years to develop a working EHR system.
- St. Joseph’s Hospital, Bangor Maine, is completing an EHR system this year. The two-year project cost about $3 million. The hospital is keeping paper records as a backup.
- University of Pittsburgh Medical Center is expanding its 1991 system to extend its capabilities and interconnectivity to 20 other hospitals and 400 physician offices.
- Health Information Exchanges (HIE) — in which a group of hospitals/clinics or state and federal public health organizations exchange health care information — have potential, say supporters, pointing to the 500-member Community Health Information Collaborative in northeastern Minnesota.
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- Cedars Sinai Medical Center, Los Angeles, spent $34 million on a computerized records system, but ceased using it after three months because several hundred physicians complained it overwhelmed them with too many alerts, reminders and questions.
- Kaiser Permanente decided to write off 40 years of effort and a $400 million investment in an early attempt at implementing EHR technology in conjunction with IBM. It has now purchased a functioning EMR system at a cost of $4 billion.
- Britain’s effort to implement a national EHR system has thus far cost $18.6 billion, and is four years behind schedule because of software and vendor problems.
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Where Will the Stimulus Money Go?
Beginning in January 2011, hospitals will be eligible for a base amount of $2 million for installing EHR systems, with the possibility of getting up to $11 million.
Individual doctors’ offices that serve Medicare and Medicaid patients can receive $44,000 and more in incentives for installing systems that make “meaningful use” of EHRs (this term has not yet been defined).
Offices installing EHR systems in 2011 and 2012 will receive more money than those who wait until 2013 and beyond.
Beginning in 2015, care providers without EHR systems will incur financial penalties in the form of reduced Medicare incentives.
Because incentive payments will be spread over five years, physicians and hospitals most likely will have to pay for their systems out of their own pockets.
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