US president elect Barack Obama said that after he takes office later this month the government will be investing money to make sure that the health records of all Americans are computerized within the next five years.
According to AP/ABC News, Obama said in a speech he made last Thursday from George Mason University in Fairfax, Virginia, that such a move will not only reduce cost and improve quality of health care, it will “cut waste, eliminate red tape and reduce the need to repeat expensive medical tests”.
Obama said it was not just that billions of dollars will be saved, lives will also be saved because digital records will reduce the “deadly but preventable medical errors that pervade our health-care system”.
However, to save billions, it may cost billions. Independent studies from the Commonwealth Fund, Harvard and others estimate such a project could cost from 75 to 100 billion dollars over ten years, said a report by CNN Money.
In a radio speech he made on Saturday, Obama referred again to this ambitious goal, explaining that his government will be creating “hundreds of thousands of jobs” so the US can move to a “nationwide system of computerized medical records that won’t just save money, but save lives by preventing deadly medical errors”. This forms part of Obama’s “Turning Around Unemployment” plan to find over a million jobs in clean energy, education, repairing infrastructure and health care reform.
The kind of information that is held in a digital health record is that which currently sits in computer systems in hospitals, insurance companies, clinics, and physicians’ surgeries, to keep track of what is happening to patients. Each institution has its own system, with its own way of storing and retrieving records, and it is not easy for information to pass from one to the other smoothly.
Obama’s plan is to have one standard electronic record system that all institutions use and share. But that will not be easy. According to a report in CNN Money, only about 8 per cent of US hospitals and 17 per cent of physicians use the kind of electronic medical record system that Obama thinks the whole country should be using. Plus, experts say there are many concerns about patient privacy once records become easy to manage and share.
And last, but not least, where are the skills going to come from? Finding work for hundreds of thousands of unemployed people sounds good, but IT skills take time to to acquire, and the more specialized they are, the longer it takes and the harder it is to find people with the right skills. This is probably where most of the money will have to be spent. A senior vice president of Siemens Healthcare who design health care information systems, Luis Castillo, told CNN Money that the people who design the system will have to think like doctors.
Dr David Brailer, former National Coordinator for Health Information Technology who worked with President Bush’s administration from 2004 to 2006 said that it’s not as easy as dropping a computer on every doctor’s desk. There are a lot of difficult technical problems to overcome.
But Dr Bill Crounse, who is the senior director of worldwide health for the Microsoft Corporation, said that he was thrilled about the news. The opportunity is not just about medical records, said Crounse:
“The opportunity is really to think in entirely new ways about how you do health care,” he told ABC News.
Microsoft could be a major force in the development of a new national system. In 2007 they launched a beta version of Healthvault, their prototype online medical records system. Their partners in the venture include Kaiser, the American Heart Association, and the Cleveland Clinic.
Internet giant Google has also launched a web-base medical records system called Google Health, and is gradually signing up various medical organizations. For instance, last month Blue Cross Blue Shield of Massachusetts (BCBSMA) members joined the system. BCBSMA’s Vice President of Provider Network Management, Steven Fox said that their members wanted easier access to their health care information and to be able to move it around easily.
“”Having this information in one place can help our members and their doctors make health care decisions that can improve the quality of care they receive,” said Fox.
As with all designs where existing methods are collapsed into one system, the definition of what constitutes an electronic health or medical record will have to be decided clearly and unequivocally early on. Does it for example include the facility for doctors to order tests, or does it just record the results of tests? And if so, to what level of detail? Will it be used for billing? Who will have access to the information and who will control the access?
As Robb Webb, CEO of OptumHealth Care Solutions, a company that develops electronic medical records technologies, explained to ABC News:
“Electronic medical records could constitute anything from something as simple as the note that contains a doctor’s decisions to the underlying data that led to those decisions.”
Some of the prototypes already being tested have gone some way to addressing these problems, and thus already have some vested interest in their own definition of what constitutes an electronic medical record. It would seem that one of the first tasks of such an ambitious project will be to set up a standards committee, with representatives from all aspects of the problem, not just to address technological and ease of use issues, but also the ethical and privacy issues.
And while all that is going on, someone needs to examine the legislation, which was not designed to cope with online, web-enabled sharing of health records, and kick off another strand of debate and reform.
Five years is beginning to sound impossibly tight when such hurdles are considered.
Sources: CNN Money, ABC News, MNT Archives.
Written by: Catharine Paddock, PhD