E-records vital to health strategy

HHS report: Decade of Health Information Technology

Transforming a paper-laden, fragmented health care industry into one that uses electronic health records will be an enormous undertaking, according to health care advocates who say federal leadership is crucial.

Dr. David Brailer, whom President Bush appointed in May as the country's first national health information technology coordinator in the Department of Health and Human Services, has shown how he intends to marshal the effort. His 10-year plan, "Decade of Health Information Technology," is a blueprint for a national health care information infrastructure to transform the industry and lower health care costs.

The plan, which officials released at a recent health care meeting sponsored by HHS, is meant to stimulate discussion among government, industry and health care officials about how to improve health care and reduce costs using electronic health records, Brailer said.

"This is not about the technology itself," he said. "This is about what it does in real patient care."

The plan's proponents say an interoperable health IT infrastructure would improve care and reduce medical errors, which result in 44,000 to 98,000 deaths each year, according to Brailer's findings. Among the plan's benefits would be improved decision-making among doctors and providers, better research and public health monitoring, enhanced privacy and more accuracy for medical records.

Electronic health records potentially could save between $78 billion and $112 billion a year by reducing tests and improving administrative procedures, according to recent health care statistics cited in Brailer's plan. By some estimates, $300 billion -- or 30 percent of health care spending each year -- is for treatments that do not improve a patient's health, are redundant or are inappropriate.

The health care industry has been slow to adopt electronic records. In 2002, only 13 percent of hospitals and between 14 percent and 28 percent of physicians' practices reported having electronic health records systems, according to recent industry statistics. Advocates say federal leadership is crucial because the private sector has failed to move to electronic medical records during the past 20 years.

Harris Miller, president of the Information Technology Association of America, said the IT industry has a tremendous opportunity to make a profound impact on health care by giving doctors and hospitals a means to quickly share accurate information.

But because the health care industry is fragmented, it is difficult to get the players to agree on IT adoption or make the necessary financial investment, Miller said. "They've all got their own little rice bowls they've been protecting," he said.

To proceed according to Brailer's plan, health care reformers need to initially focus on patients gaining ownership of their health records, said Anne Woodbury, chief health advocate at the Center for Health Transformation, a nonprofit group founded by former House Speaker Newt Gingrich.

Additional work will be needed to develop standards, achieve interoperability among existing systems and provide funds to help hospitals, health care groups and small medical practices adopt electronic health records, she said. Consumer groups and organizations that offer long-term care, home care and wellness programs must become involved, she added.

"Now the devil is in the details, but the reality is [that] getting everybody on that same vision is an enormous task," Woodbury said. Money is also a concern. Center officials have proposed that Brailer's office be made permanent and given a meaningful budget.

Miller said today's interoperable technologies, such as Web services, can help achieve Brailer's 10-year plan. There are also studies, he said, that document a return on investment from using technology to improve care and reduce costs. "It's just plain old inertia trying to hide behind the cost issue," he said.

Throughout the country, HHS officials are providing funds for several pilot projects involving electronic health information exchanges. Officials at the Centers for Medicare and Medicaid Services are testing a Web portal in Indiana where Medicare patients can gain access to their health care information. The same officials also are working on regulations dealing with electronic prescriptions.

In addition, HHS officials are collaborating with officials in the Departments of Veterans Affairs and the Defense Department on health

IT projects to benefit employees and beneficiaries. HHS Secretary Tommy Thompson has said he will appoint a panel to assess the costs and benefits of health IT. The panel will issue a report in October.

At the HHS summit, one patient gave a personal account of the toll exacted by continued use of nonelectronic medical records. David Koopman, a 44-year-old Boston-area technology professional with a degenerative heart condition, explained that several weeks ago, his medication dosage was adjusted to control his heart arrhythmia. But instead of getting better, he began having fainting spells. He admitted himself to a suburban hospital and stayed three days.

When he met with his regular Boston cardiologist four days later, he discovered that his medical records had never been transferred from the hospital to his doctor's office. Koopman said he drove back to the hospital to get his records but was told they would be mailed to his doctor in several weeks. Consequently, his cardiologist had to repeat some tests.

Koopman estimated that the extra day he spent in the hospital and the redundant procedures probably added up to $5,000 in unnecessary costs.

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E-HEALTH PLAN

A 10-year plan for creating a nationwide health information technology infrastructure rests on four strategic objectives. Released this month by the nation's first health care czar, Dr. David Brailer, the objectives include:

Bringing electronic health records into physicians' offices, hospitals and clinics.

Linking health care practitioners through a shared information infrastructure based on common standards and technologies such as Web services, authentication and other security tools.

Enabling patients to manage their health care information, including their personal health records.

Improving public health by promoting better health surveillance systems and accelerating research.