Medical records: the digital movement to convert paper documents gets a boost

Most everyone agrees that getting doctors to convert paper health records to a digital system makes a ton of sense. Physicians could immediately pull up your lab data, scans, medical allergies, and other key information on the spot -- regardless of whether you're just seeing your regular physician or you're on an ER operating table.

Problem is, these systems don't come cheap. A September 2005 study in Health Affairs calculated an average cost of about $44,000 per physician to install an electronic health-records system -- not including any ongoing maintenance costs. But the barriers to adoption may finally be falling.
A $400 million grant program announced this week would provide up to $40,000 to New York–area physicians over five years to implement electronic health records. The North Shore–Long Island Jewish Health System program seeks to automate inpatient and outpatient records in all medical settings, including 13 hospitals. "No comparably sized hospital system in the country is providing this level of financial assistance to so many physicians to integrate an electronic health record," says Robert Williams, director of Deloitte Healthcare Consulting.

The move is one small positive step in a nationwide effort to wire up doctors and hospitals -- an effort President Obama says he supports. Small physicians offices treat about half of the patients in the United States, yet only 17 percent report using electronic records, according to a recent study in the New England Journal of Medicine. And experts call the lack of communication and coordination among doctors, specialists, and hospital systems one of the biggest problems in our health system.

Between 2004 and 2006, as many as 238,337 deaths in the U.S. were potentially preventable, according to healthcare rating company HealthGrades. Some could have been avoided with electronic health records, which could more easily flag patients with other underlying conditions or who could experience dangerous drug interactions. There have been similar incentive programs to move physicians into the paperless age. In June 2008, Medicare announced a $150 million grant to help 1,200 small physician practices in 12 cities switch to electronic records.

The North Shore–LIJ system plans to roll out its system this fall. As part of the program, "automated care guides" will "improve clinical care, prevent illness, and avoid medical and drug errors," the health system says. Powered by health-care software company Allscripts (MDRX), the system will be subsidized by up to 85 percent for doctors who agree to share their performance data, so it can be compared against national standards for superior care and outcomes. Doctors may also be eligible for up to $44,000 in additional federal stimulus money over five years for the electronic health record project.

"With this initiative, North Shore–LIJ is ensuring that physicians across the entire market area it serves not only have immediate access to the latest care guidelines, as well as access to patient information from every care setting, whether it's their own office, the emergency room, or another clinic in town," says Glen Tullman, CEO of Allscripts.

That sounds promising, but for electronic health records to be truly effective, they will eventually have to be rolled out across the nation as part of an integrated system. (If you're a North Shore–LIJ patient with drug allergies who needs emergency care in California, you'll need an electronic health-records system that can communicate beyond a local or regional network.)

There's good news and bad news. There is a government-led initiative designed to encourage a patchwork of electronic health record systems -- a "network of networks" -- that could be stitched together once standards have been agreed upon. But the bad news is, building the Nationwide Health Information Network, as it's called, could cost as much as $276 billion over 10 years, according to the Health Affairs. And this being a government initiative, it's nowhere close to meeting the goal of completion by 2014.

That said, news of the latest grant program suggests large health systems increasingly understand the benefit of getting all of America's hospitals, doctors officers, pharmacies, patients, and others wired. A separate study released on Thursday said that 76 percent of healthcare executives now believe their biggest asset over the next five years will be the health trend data that electronic health records can provide, according to PricewaterhouseCoopers. The California-based Kaiser Permanente health system, as one example, determined that the pain drug Vioxx increased the risk of heart attacks by combing through its electronic health record system, leading to the drug's removal from the market in 2004.

"Physicians are committed to providing the best possible care for their patients," Tullman says. "But to deliver, they need just the right information at just the right time."
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