The stimulus package will devote $20 billion to build the infrastructure of an e-health system, replacing paper records with digital ones that could be cheaply and easily stored and shared. As the New York Times aptly noted on Sunday, protecting the privacy of e-health records is both pressing and daunting. Although upcoming posts will tackle the privacy issue, a threshold discussion concerns the extent to which this proposal will change current practices and health care professionals’ readiness to digitize their work. Health care providers, on the main, are firmly rooted in twentieth-century practices. A recent New England Journal of Medicine survey of 2,700 U.S. doctors revealed that only 4% used “fully functional” e-health records systems and the remaining 96% stored their patient information in paper files. CNN Monday.com reports that only 8% of the nation’s 5,000 hospitals and 17% of its 800,000 physicians use the kind of computerized record-keeping systems that President Obama envisions for the nation. Computerworld offers more optimistic numbers, suggesting that 25% to 35% of the nation’s hospitals use, or are in the process of implementing, computerized order entry and medical record systems capable of sharing patient data among hospitals, doctors, insurance companies, and pharmacies.
Of course, getting doctors computers for their desks won’t do the job. Systems must facilitate safe information sharing. For instance, physicians and hospitals require record-keeping technology and point-of-service technologies, such as notebook tablets for data entry into e-health record systems. Thirty states have made some strides in this direction, introducing or passing legislation that calls for statewide adoption of standardized health IT systems. Massachusetts wants 14,000 private physicians’ offices to adopt e-health records systems by 2012 and its 63 hospitals by 2014. According to the Vice Chairperson of the Massachusetts e-Health Collaborative, the plan will take two to three years and cost $100,000 per physician. Private hospitals have been innovating as well: Duke has created an online medical record site accessible by patients who can share the data with whomever they chose. The CIO for Duke University Health System explains that its portal is akin to “online banking or Expedia account, which pulls information from various sources and displays it to you. You can pay your bills online, schedule appointments online.” Duke uses Google Health and Microsoft Healthvault to permit information sharing beyond its campus.
All of this suggests that health care providers have much work to do, and much money to spend, in transitioning into the e-Health Information Age. Although strong evidence suggests that the downpayment on a digitized health records system is worthwhile, potentially saving the health industry $200 billion to $300 billion a year, we need to spend the money wisely. It would be shameful if we rushed into the project, in much the same way that states acted too quickly to spend the Help America Vote Act funds and ended up buying inaccurate and unsafe electronic voting machines. Let’s be sure not to do the same here.