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Pushing E-Health Records
Brown University medical student Jeremy Boyd displays his personal digital assistant, or PDA, Friday, Feb. 17, 2006, at Memorial Hospital in Pawtucket, R.I. Boyd records patient data in the PDA and can reference drug and diagnostic programs. (AP)

Brown University medical student Jeremy Boyd displays his personal digital assistant, or PDA, Friday, Feb. 17, 2006, at Memorial Hospital in Pawtucket, R.I. (AP)

By 2014, President Obama hopes to digitize the health records of every American. And the federal stimulus bill is funneling $19 billion dollars to do just that.

Proponents say electronic medical records will reduce spending. Cut down on repeat medical tests. Reduce errors. Even save lives.

Critics warn not so fast. What about the huge cost to implement such systems? And what about doctor-patient privacy? Do we really want a universal electronic health record database?

We’ll weigh the pros and cons.

This Hour, On Point: your e-health record.

You can join the conversation. What’s your view on computerizing Americans’ medical records? Tell us what you think — here on this page, on Twitter, and on Facebook.

Guests:

Ashish Jha, professor of medicine and associate professor of health policy and management at Harvard University’s School of Public Health and a staff physician at the Boston VA and Brigham and Women’s Hospitals. He co-authored a recent article in “The New England Journal of Medicine” called, “Use of Electronic Health Records in U.S. Hospitals.”

Jennifer Brull, family medicine physician in Plainville, Kansas. Her clinic recently converted to an entirely electronic system of medical records.

Deborah Peel, founder and chairman of the Patient Privacy Rights Foundation. You can see her group’s position here.

More links:

Dr. Jermome Groopman, a highly respected medical thinker and supporter of President Obama, wrote a tough critique in the Wall Street Journal — “Obama’s $80 Billion Exaggeration” — of the new administration’s e-health record effort.

To hear how President Obama wants to cut health care costs — including through the e-health records push — listen to On Point’s show with hospital consultant Mitchell Seltzer, who has the ear of the White House, and Washington Post reporter Ceci Connolly.

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  • Chris from Boston

    Yesterday it came out that the Pentagon had data on the F-35 hacked. The Pentagon! Does anyone actually believe that health records will be protected any better than that? Any assurance that e-health records will be private is sheer fantasy. The whole idea is dangerously premature at best.

  • http://www.recomdata.com Aaron Abend

    I work with healthcare data and I believe there is enormous misunderstanding here. And as a result of this misunderstanding, the government has locked medical researchers OUT and we are limiting our ability to use this data for good. By locking out the researchers, the insurance companies have everybody thinking they have locked out the insurance companies – but nothing could be further from the truth.

    HIPAA’s privacy rules, for example, PREVENT researchers from using your data. It ENSURES that this data can move from one insurance company to another. That is why it is called the the Health Information PORTABILITY and Accountability Act. 99% of the researchers and doctors I work with think the P stands for Privacy or Patient.

    The result is that many of the institutions I work with – researchers doing work on cardiovascular disease, disparities of care research, diabetes, asthma – cannot get data because the rules everyone thinks apply to the INSURANCE companies are being applied ONLY to the rsearchers.

    Most healthcare data today is claims data – the insurance companies are already using this data to reduce costs – and in some cases, limit care. To START using computer systems for TREATMENT is hardly going to create problems for patients. Limiting the development of EMR systems only HELPS the INSURANCE companies by ensuring they maintain THEIR control of YOUR medical data.

    I work with Partners Healthcare, UMass Medical School, Harvard Medical school and many other institutions and am basically an expert on this subject. The healthcare system is definitely broken, but limiting the implementation of electronic medical records does NOT help solve any problems and only ensures the perpetuation of the current system.

    Also, in your show previews you talk about ONLINE medical data. That is erroneous. EMR systems are NOT ONLINE in the sense most people think of that word. They are implemented on secure private networks.

    So, the question is NOT whether your personal healthcare data is going to be electronic – the INSURANCE companies already have it. If you want to prevent your doctor from having your latest tests, then by all means, fight the implementation of electronic medical records if you think that makes life better for you.

  • KevinC, MD

    Privacy and security can be engineered into modern computer systems. Most EHRs are not “modern computer systems.” Health systems, however, are seldom targets of attack, and the release of a security rule in HIPAA has at least broght the issue to notice of system administrators.

    The push for adoption of EHRs at this time is premature. The existing CCHIT certification calls for a bare minimum level of interoperability, and does not support the meaningful exchange of clinical information in a structured/coded (i.e. computer readable) format.

    While even the most rudimentary (circa 1970 technology is still the norm in many large vendors) system which only captures whatever is typed into them (as narrative text), the true promise of EHRs remains unrecognized in comercial systems. Features like decision support, provider order entry, reductions in mortality and morbidity have been described primarily in home-grown systems at major informatics educational institutions.

    The level of interoperability we need NOW can be achieved, but there has been a tremendous lack of investment on the part of the Federal Government to develop the standards and other infrastructure required to support this level of interoperability.

    Also, these standards would provide the implementing vendors a guidance on “best practices” for building a modern, sophisticated EHR. This would required ~$5M to acomplish–a fraction of what is being discussed.

    Finally, the cost of EHRs is a problem. The $40K per provider to install and $5000 per year ongoing is absurd. The result of this model is every provider group has their own set of records, independant and incompatable with each other. The result of this Balkanization of health information is complete discord when someone is seen by more than a single group, or if they end up in an emergency department.

    The alternative, well known to Deb Peel, are health record banks. These independant (of payers and of providers) entities serve as custodians (not owners) of the individual’s complete health records. The individual has complete control over the use and release of information. When they are seen by a provider, the providers EHR (or even just a web browser) “checks out” the record, and can make entries. This can be done in conjunction with an existing legacy EHR as copies can be kept in both. But the key part is that the complete record is always available and always under control of the individual.

    This is the only logical alternative to the NHIN now under construction. Having a standards-based health record banking system (where people are free to choose their health record bank) solves many of the technical issues and can do so at a fraction of the cost of the system now proposed.

  • Kathy O’Riordan (pronounced O’Reardon)

    I work in a cardiologist’s office as a ultrasound technologist doing cardiac and vascular ultrasound. We have had computerized records since 2001 and I cannot image going back. We have a main office and a satelite office and either office is able to answer patients’ questions about scheduling, medications, etc. If the ER calls the office to speak with the doctor and he or she is at the satelite office, the doctor is able to call up the patient’s records and speak with the ER physician about the patient’s history and status. We even offer the patients a CD of their medical history they can carry with them on vacations – essential information necessary in an emergency.

  • Dave Doiron

    My primary care physician’s group has used electronic records for years, and I love it. Using his laptop during the examination, the doctor can immediately access my history, sometimes information from years ago. There’s no practical way he could do this with paper records. He also can send electronic prescriptions to my pharmacy after my examination. The prescription is totally legible, eliminating the chance of errors caused by interpreting a doctor’s handwriting. And it’s usually filled by the time I get to the pharmacy.

  • praveen

    1. Cost of setting up electronic systems, is a one time costs that pays every day for a long time to come unlike paper and paper handling employees.
    2. Security and privacy etc are issues that needs to be worked on and regulated. They should not be reasons against setting up electronic record systems.

  • Fahy Bygate

    My doctor does not even have email. She says that the security issues are too great. My husband’s doctor has email, he prescribes through it, checks up on my husband’s BP, etc. I would like to see more technology used by physicians.

    PS Tell Dr Ashish Jha that there is no such word as “deidentified”. The word is “unidentified” Thanks. FB

  • kitty wilkes

    I really think it is the health insurance industry behind this push for computerize medical records. As long as insurance companies are legally allowed to “shop” for healthy customers and deny coverage for whoever they choose I am dead set against electronic medical records. As it is now, if they see that you have had something as simple as a yeast infection somewhere in your distant past they can reject your current (even unrelated) claim. Universal Health Care First!

  • Alex Marthews

    A new study just out (http://ideas.repec.org/p/net/wpaper/0716.html, forthcoming in the journal Management Science) suggests that strong regulation of healthcare privacy slows down adoption of electronic health records by about 25%. If we want strong patient privacy, that’s fine, but it will come at a cost in terms of how fast EMR spreads; which in turn is likely to cost lives and will disproportionately affect African-Americans (who appear to benefit more from the spread of EMR).

  • Joanna Drzewieniecki

    I support this with one caveat. Patients’ ENTIRE records must be digitized. My 94-year-old Dad gets treated at a Veterans hospital. They digitized records back to a certain date (about 20 years I think) and doctors no longer have access to previous information. Therefore, for example, they do not have access to the original incident that led my father to have a pacemaker installed. This has not led to a life-threatening situation but I would feel much more comfortable if they had all the records computerized. Otherwise, doctors should have EASY access to previous written information.

  • Tom Mannle

    I was involved in the first cost-benefit analysis of the implementation of Physician Order-Entry and Computerized Patient Record System (CPRS) in the VA, in 1996. The analysis clearly showed that there were significant cost savings, in particular the time from order to administration, and prevention of adverse events

    Now, VA has the largest implementation of EMR anywhere…..and I get my own healthcare at the VA, and I wouldn’t go anywhere else……the continuity of care across providers is a HUGE benefit for patients who see multiple providers…….no time wasted, and patient time is not, by and large, figured into any cost-benefit analysis…..but should be……

    Sure there may be costs to individual providers, but the societal benefits far outweigh the initial investment……

    Tom Mannle
    Gloucester MA

  • Sherm Grossman

    One doesn’t have to go much farther from Boston to find a great e-records system: Harvard Vanguard Medical Associates uses the Epicare system. From a patient’s point of view, it’s fantastic. I can sit in my PCP’s office and watch him call up every record, test, vaccination, Radiology report, etc. and we can talk about it on the spot. While I was hospitalized, the attending physicians could do the same thing.
    I can access my records, too, via a secure web site. I can send my docs e-mails, make appointments, ask questions and get responses and find all my prior test results.
    As far as obsolescence, if one choses a fly-by-night software firm for the system, one can expect to eventually have to convert to a more stable system/provider.
    I think all the negative comments one hears from the physicians is code for “I don’t want to do the data entry myself.”

  • Sandra Coutsakis

    I personally have benefited when doctor’s have digitized files and are able to access various files.

    In addition to being strongly in favor of electronic files I think each patient should take responsibility for their own medical records. What I do is request a copy of my record from the doctors and labs in addition to copies of CT, PET scans and x-rays as well. I scan all information on a memory device which I carry with me for any infomation needed in an emergency (or otherwise) situation.

    As far as accuracy I think the bottom line is that a patient should be responsible for accuracy of information and look over all information to avoid transcription errors.

  • Shed Skin

    Our miserable excuse for a health care “system” has gaping lacerations & all y’all can discuss is which color of band aids people like better.

    Sure electronic records will bring some benefit, but they’ll also be subject to hacking. There’s no need to have ANYONE’S records online. Individuals can wear bracelets/necklaces with pertinent medical info, you know, like diabetics & epileptics ALREADY DO.

    Anyway, discussion of electronic records as an issue(instead of a red herring, which it is, did you fall for it?) by you when we are THIS CLOSE to gaining SINGLE PAYER HEALTHCARE for the USA is betrayal. Please have the spine to air shows about SINGLE PAYER & TRUE health care reform, you know, like House Resolution 676.

  • KC

    I am also a VA patient and appreciate the electronic health record system. Due to its implementation and user interface it does occasionally interfere with communication. The VA system needs work, for sure. But having my record in one place is the only reason I put up with the otherwise haphazard and disinterested care the Boston area VAMC provide.

  • balu raman

    Ah,EMR. Sure, we should be going towards all EHR, the advantages far outweigh most of the disadvantages, barring privacy issues. The cost and the perennial costs, year after year, if they are being sold by proprietary vendors – vendor lock-in etc. CCHIT is a shady organization started by these private vendors, keeping out smaller players, that our federal govt insists that the EMRs have to be certified by. The alternate solutions lie in Open Source solutions like OpenEMR, OpenVISTA, and many others. Here the software is open and can be read by any competent s/w person and one could hire a 3rd party consultant for enhnacements etc. preventing One Vendor calling the shot. Besides, there is enormous research that Open Source is much more secure. Don’t you want the FREEDOM to see the source ? Would you buy a car that comes with its hood shut that you can’t look in ? There, something to consider.
    - balu raman

  • Kevin

    Shed Skin has a good point. Having interoperable EHRs is only one leg of what we need to fix the American health system. What we need is:

    (1) Comprehensive interoperable electronic health records
    (2) Universal coverage (single payer or some other Gov’t funded equiv.)
    (3) Tort reform. Most cases brought against physicians are spurious or otherwise bogus. Nearly all that go to court the physician “wins” but only after intense emotional pain, $50,000 to their laywers, and time away from their practice. The current tort system pushes health providers to over test, over consult, and avoid making important decisions for fear that if something goes wrong (and things always go wrong–there is a 100% risk of all of us dying at some point).

  • Abdul Shibli and Yvon Jeannot

    We work with doctors and other providers. Most important piece: training and good technical support.

  • Felipe

    Electronic health records will be integrated into other forms of electronically stored data on people via various forms of identification such as driver’s license numbers, social security numbers, passport numbers, names/ aliases, relatives, social networking sites, credit card numbers, etc…

    Comprehensive compilations of information will be continually gathered & expanded on each individual in the system from what they buy to where they go. If what some say is right, RFID chips will be first introduced to the elderly on a voluntary basis. Remember LifeAlert’s “I’ve fallen & I can’t get up?” RFID chips have already been experimented with in animals.

    All new drivers’ licenses and passports already have trackable RFID chips. Eventually, all forms of tracking & data collection will be integrated and made accessible at the push of a button. And if you can be scanned & tracked by radio frequency like an animal on national geographic, then any camera in the world can be turned and focused on you. This is already done extensively in Great Britain.

    Eventually, when we become a cashless society, all of our finances & ability to economically participate will be at the mercy of someone else at a computer screen who is hired to follow orders in the name of global security.

    Lastly, the problem is that not only will Big Brother be watching you no matter where you go BUT also it will be possible to plant false information into peoples’ comprehensive records with the purpose of framing them – from the same source using administrative priveledges (oops – accident); OR, even worse, you could just as easily be erased from the system entirely. Would it be possible to trace or investigate? No, because there will no longer be a paper trail available.

    Most likely, electronic healthcare is part of a plan to dismantle Veterans’ hospitals & Veterans’ healthcare as all hospitals will be electronically integrated and consolidated for profit. This will be necessary as globalist wars continue for possibly the next several decades and as there are more & more veterans in need of health care. Privatizing veterans’ health care will shift their healthcare off the governments’ budget. Private healthcare will be more expensive leading to more financial debt and financial control of society.

    Take care of your health, people, as best as you can. And you know how… The caduceus (the symbol with the snakes) is seen on the Blue Cross & Blue Shield Logo as well as on British money. Do you know what it represents? It is carried by Mercury, the Roman God that is associated with merchants, shepherds, gamblers, liars, and thieves. Take heed, everyone. This is a long term project that is meant to take several generations to implement.

    Electronic health records? How about picking up the phone & calling or faxing. Isn’t having a hard copy at hand a good form of insurance?

  • http://twitter.com/1samadams Sam Adams

    There needs to be clear communications around the difference between and Electronic Medical Record (EMR) and a Personal Health Record (PHR).

    Hospital systems and smaller offices must absolutely consider leveraging EMR’s for their practices – it’s insane to think you can bring about process improvements and cost savings by staying on paper, especially in anything resembling a distributed environment – which essentially defines the fragmentation of care in todays healthcare environment.

    Towards that effect, these disparate EMR systems absolutely need to be able to interchange RELEVANT DATA to improving patient care – the main obstacles here are a real data interchange\interop standard (sorry, HL7 is a recommendation not a standard) and obstacles from major HIT vendors who can’t see past the same old way to add to their bottom line.

    PHR’s are an entirely different story and their best bet for success are if they are opt-in and allow the power of sharing to be in the consumer’s hands – reference the Microsoft Health Vault model.

    Is anything online ever going to be secure? No, never. But at some point you have to draw the line between security and usability and the benefit you get from having your healthcare information online – if it defragments healthcare and improves the quality of service, there’s too much value to walk away from in the name of (unrealistic) security concerns.

  • Frederic C.

    The consumer/patient should be protected in such a manner that even if information if acquired by persons with bad intent they will not suffer harm.

  • Rick Evans

    Great points Aaron Abend. Your lucid post largely summarizes the situation. That said, secure systems hardly guarantee safety. Credit card data was supposed to be secure until incompetent organizations such as The Gap stored data they had access to on insecure servers. Why would we expect any different from medical vendors and users? Of course I do recognize that credit card numbers and social security numbers are more valuable to criminals than are medical records.

  • http://www.visitrend.com John T. Langton

    While privacy and security concerns are all valid (although some are unfounded and ill-informed), this is inevitable. So you folks really need to start thinking about how to address these issues, and still move forward. Legal protections – e.g. making sure an insurance company can’t take your records and then make decisions based on them, should be the focus. How do you protect folks if their records are compromised. Then you setup regulations to try and prevent that from happening. But yes, any technology is only as efficient as the people using it.

  • Donald Green MD

    There are fundamental principles that must be set down for electronic medical databases. In the case of the EMR its purpose is to record and retrieve the personal interaction between a patient and their provider. Trying to combine this important function with other uses interferes with a provider’s ability of take responsibility and corroborate the information that is being put into the record. Such added things as patient portals, inter-institutional communication, making appointments, or data mining for other uses is not the basic reason for a medical record. Seventy per cent of practices in the US are small practices of five or less physicians and need a tool to put down their data and thoughts, not serve the desires of other players. Having separate data collections where each producer is in charge of the information they collect assures someone will be liable for what they put down. Otherwise with many users no one is assigned to verify the input. The result will be major errors, havoc, and quite frankly potential harm to patients. This is not to say patients should not have access to whatever care they receive, they should. However it must be in the proper context and in a form that they become the keeper of their own records. It should not be folded into what professionals must or wish to document on the patients with whom they are directly involved. Anyone seeking to do research, obtain information for other purposes will need to seek the proper permission, gather it under considered guidelines, and then enter it into their specifically designed database.

  • Joan Simmons

    I work in a hospital Medical Records and we are moving slowly to electronic medical records. The concept has been talked about,argued about for last few years.

    Its almost cost prohibitive for hospitals to convert. It is not as easy as everyone is making it out to be, its a difficult process. Mr. Obama needs to visit a hospital like us that is hybrid and really get the picture.

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