Health care experts warn of challenges for IT adoption

WASHINGTON--President Obama has called health information technology the "low-hanging fruit" of health care reform, but implementing the use of electronic medical records nationwide will be incredibly difficult, experts warned Wednesday, especially without larger health care reforms.

The Congressional Budget Office estimates (PDF) that the use of electronic medical records could save the nation $12.5 billion over 10 years, and other analyses give more optimistic figures.

At a forum here on Wednesday, hosted by the conservative think tank the American Enterprise Institute, health care providers and buyers attested to the improved quality of care and efficiencies that can result from the use of properly implemented electronic medical records. Yet without new policies to incentivize the use of health IT systems, the stimulus funds may go to waste, they said.

"We have an incredibly complex industry that doesn't necessarily want to change," said Joseph Swedish, president and CEO of Trinity Health, a nonprofit health care provider that includes 44 hospitals in its network. "I think the stimulus can prime the pump, but we have to recognize the daunting task ahead of us."

The American Recovery and Reinvestment Act directs health care providers to electronically record patients' health information for "biosurveillance and public health" and "medical and clinical research" as part of a "nationwide system for the electronic use and exchange of health information."

However, Swedish and other health care experts said providers will be reluctant to share data--or even use health IT systems in the first place--because of the pay-for-service structure and other institutional characteristics of the health industry.

Coordinators of a federal health care IT initiative have said developing a national health IT network will be extremely difficult and slow going because of the endless number of varying standards for medical health records applied in different states and localities.

Yet Benjamin Sasse, an assistant professor at the University of Texas at Austin, said Wednesday that providers themselves--not a lack of consistent standards--are the biggest roadblock to a nationwide health information exchange.

"The standards problems are absolutely real, but if you want a sticky patient, why would you ever make a patient portable and available to your competitor?" he asked. "Most of the reasons we don't have (health) IT have nothing to do with IT."

"There are a lot of complexities with the sharing of data...I don't envision in the near term being able to work with others."

--Joseph Swedish, president and CEO of Trinity Health

Trinity Health, along with Kaiser and the U.S. Department of Veterans Affairs, has one of the nation's largest integrated, single-platform data management systems and is using its repository of information to adopt more evidence-based treatment. However, Swedish said, Trinity is not sharing data with Kaiser or other providers.

"There are a lot of complexities with the sharing of data," he said. "I don't envision in the near term being able to work with others."

Trinity rolled out its health IT network in 2000 and incurred operational costs that greatly exceeded estimates, Swedish said, but also achieved more benefits than anticipated. Its hospitals, for instance, administer emergent medications 40 percent faster, and Trinity's nurses have increased their bedside attendance of patients by 8 percent now that they spend less time on paperwork.

"We have witnessed lowering costs and what we believe is better quality," he said. "We believe the investment is absolutely the right thing to do in the modern world we live in today."

Still, he said, the process took years to implement, the benefits would not have been possible with just the IT--a change in culture and staff processes was also necessary.

The economic structure of the health industry does not only deter providers from sharing information, but also from simply adopting health IT in the first place, Sasse said.

"Health IT is (part of) a much larger debate around payment reform that would provide much higher care than the fee-for-service system does today," he said.

[gregs.mailbox]

Electronic medical records. Our medical facility uses them and have been for 3 years. The only thing I have seen is how billing reaps more money. New patient charges have always been present to offset having to enter the patients information and insurance along with a history and physical. Now with electronic records when you see a new doctor in the same facility it is a new patient charge for $200.00 using information already collected and used during the visit. Big rip off of insurance money and patients without insurance.

[RobertFHarwood]

More then a decade ago American National Standards Instuitute (ANSI) came out with standards for healthcare and insurance information as part of Electronic Data Interchange (EDI). Hence there is no reason for a propietary system, just format the information to the standard. Use Electronic Digtal Signatures (PKI X.509) to encrypt the data in transit and authenticate it. Health and Human Services could use a array of Petabox drives to store the data as XML within the ANSI standard. Make it compulsory for providers paid with Federal money (Medicare, Medicaid, SSI, Veterans, Indian Affairs, etc) to file all of the data in the system in order to be paid. Yet keep it open to all licensed providers, payers, for free. This way the payers (insurance companies, union benefit plans, self insured employers, etc.) have no reason to create their own system, with its costs. They can create an interface to their internal system.

Sure software companies like my own will complain about the lost oportunity. We can still create the front ends and interfaces to other systems (such as accounting).

Only a big stick will get this done. Carrots have not worked. They don't comply, they don't get paid. Come to think of it pull their license to practice and padlock the office after you take all the records to be transcribed to the system and bill them for the work.

The standards are already implace. There is already goverment bureacracy inplace to handle it.

[Bristol Slim]

For one thing, I don't know why even the dumbest man on the street can believe anything from the AEI or its benefactors. Remember going into Iraq and the parades and candies? Yeah. That was them, too.

For another, you can count on a continuing drumbeat of gloom about the "complexities" of e-record sharing and privacy issues, since the overwhelming majority of Americans are now ready to embrace some kind of radical change in the way healthcare is handled in the U.S.

It was about 5 years ago that my scripters made data move from 5 big iron systems from the '70s & '80s into a SQL DB, and made it accessible via a browser to the client and to inside reps. Now my outside reps access it in the field. Billing, pricing, contact info. Very sensitive stuff.

The statement about "complexities with the sharing of data" is nonsense. I believe what he's saying is, "this is going to be hard, it's going to cost me something on my bottom line, and I don't want to do it."

These fatcats in the hospital system see that the writing is on the wall: no more 7-figure executives who couldn't find their perl scripters with both hands in broad daylight.

What scares me most is Microsoft's interest and coziness with D.C. on this issue. Can you imagine the spiked increase in data leaks of your personal health info if Microsoft were to take a lead role? How about the intentional incompatibilities and other monopolistic practices that will stifle innovation in this area. And, yes, of course the Blue Screen of Death and other instabilities/inconsistencies prevalent with Microsoft technologies will no doubt impede critical care.

[JEngdahlJ]

It?s funny how contentious issues play out: There?s the real evidence about the effectiveness of electronic health records, and then there?s the hype. We tend to hear more about the promise, less about what has been proven.

With EHR, what?s been proven is that having doctors in hospitals use the computer to enter orders that are legible, with the correct decimal point, and that can?t be mistaken, reduces medication errors dramatically. Further, the turnaround time from when an order is written until when the medication is delivered to the patient can be markedly reduced.

Just putting computers into a broken healthcare system makes it faster and more expensive ? and still broken. We have other things to fix as we implement these systems if we're to accomplish effective reform. EHR is perhaps part of the solution but not the silver bullet. More at http://www.healthcaretownhall.com/?p=93

[s.ge]

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