Wyoming plans e-records for health

Wyoming EHR study legislation

Wyoming has started developing a statewide electronic health record (EHR) system, but people should keep in mind that it's a long-term project that will require additional legislation and funding, said the Wyoming Healthcare Commission's leader.

The commission will make recommendations for development of a statewide health records system this September, said Anne Ladd, the group's director. One of the first projects would develop a regional health information organization, Ladd said. The commission can set up the organization with community groups without the need for legislation, she said, though the commission may eventually look to the Wyoming Legislature for funding.

Commission members are using a study and draft recommendations prepared last month by John Snow, a health consulting firm, as a template for a statewide health records system. That study emphasizes the need for broadband Internet connections.

Wyoming already has a broadband network serving every school in the state, but legal and capacity barriers block the use of that network for anything but schools, Ladd said. The state's Telecommunications Council is working to develop a broadband network that could work for EHRs, Ladd said.

Broadband access in the state is not a major problem except in small medical offices in isolated communities, said Dr. Geoffrey Smith, a Casper, Wyo.-based radiologist and chairman of the commission's Information Technology Technical Management Subcommittee.

Paying for doctors' systems could be the main financial hurdle, according to the John Snow report, which estimates that a standardized EHR system could cost $40,000 to $50,000 per medical provider. Wyoming law states that any public funding has to go toward the greater good of the state and its citizens, which could preclude direct funding of doctor systems, Ladd said.

The commission is exploring the use of financial incentives through Medicare reimbursements to spur state physicians' adoption of the EHR system.

The John Snow study found that Wyoming doctors view e-prescribing as the single most popular and acceptable computing application, with a statewide e-prescribing initiative leading to reductions in errors caused by poor handwriting. The Department of Health and Human Services published e-prescribing rules in January and expects to have standards in place by January 2006.

Concerns about the security and privacy of electronic medical records in Wyoming must be addressed up front, the John Snow report authors wrote. "The citizens of Wyoming may be characterized as fiercely independent, with a strong desire for privacy and minimal intrusion from state and federal agencies," the report states.

Last week, Dr. David Brailer, national health IT coordinator at HHS, said he views privacy and security as linchpins of the agency's nationwide health IT strategy. If the department's EHR plans are to succeed, HHS needs to engage in a "social dialogue" with the public about EHRs, privacy and security.

State officials should solicit public opinion and create a structured information-sharing program with the public and health care professionals about the benefits of an EHR system, the John Snow report states.