Your e-health future

Dragging health records into the Digital Age

Walk through a typical Kaiser Permanente doctor's office or hospital, and you won't find a paper chart lying around. Kaiser, with 450 hospitals and offices around the country, is almost entirely paperless.

But as the rest of the health care industry rushes to follow in Kaiser's digital footsteps, Kaiser's paperless success story--a 10-year, $4 billion effort--might actually serve as a cautionary tale.

By no means has the Kaiser e-health project failed. In fact, besides some hiccups, it has gone well: Kaiser said it has seen more satisfied patients and a slight dip in emergency room visits and hospital stays, which cuts costs. Even the doctors grumbling the loudest beforehand don't know what they would do if they were forced back to paper.

Unfortunately, the rest of the health care system looks nothing like Kaiser.

Credit: Ina Fried/CNET

Kaiser Permanente is testing a tablet computer to enter
health care information within its hospital walls. It has
been using a desktop cart on wheels, but the tablet is
less intrusive and can run longer without needing a charge.

Kaiser is a rare beast: both an insurance provider and medical provider. Investing in digital technology was projected to create efficiencies in its medical services and boost the bottom line.

Most hospitals don't operate like that. They provide a service, bill the insurance company or the government, and move on to the next patient, efficiency be damned.

Nonetheless, the United States appears to be barreling ahead with a far-reaching health care digitization effort that even proponents say leaves many questions unanswered. The Obama stimulus package provides $19 billion for hospital technology efforts, which could go a long way toward prodding penny-pinching hospitals and doctors to finally leap into the 21st century.

But then what? Most experts believe that $19 billion is only a down payment on what it will really take to digitize American hospitals. What's more, successful digitization will require the reinvention of the rest of the medical industry--with insurance companies on one side and doctors on the other, in an often-nasty tug-of-war over patients and dollars. That means a change in policy as much as technology, and perhaps the most drastic overhaul of an industry in American history.

"What I worry is that there are some very, very high expectations that may result in significant disappointment," said Andy Wiesenthal, the doctor who helped set up Kaiser's system. Digitizing the whole country's medical records could take a decade of sustained commitment, and "as a country, our attention span is not lengthy," Wiesenthal said.

"Finding 50,000 high-quality professionals is going to be hard," said John Halamka, who serves as chief information officer of New England's CareGroup Healthcare System and also chairs the U.S. Healthcare Information Technology Standards Panel. "The one thing you do worry is that there are going to be a lot of fly-by-night companies. There has to be real vigilance to make sure people are actually getting what they are paying for."

Unfortunately, it's neither clear from where all those new workers will come, nor who will be policing for shoddy technology acquired in a government-funded buying spree.

In a three-day special report, CNET News will take a look at the rapidly digitizing health care industry and try to answer the question: What took them so long? In the process, we'll explain the dangers inherent in the digitization, what the stimulus plan and e-health legislation means to the average person, and maybe inch a little closer to answering one of the most vexing questions of American medicine: why are doctors such Luddites?

If the country's hospitals really are going to go digital, they would do well to be asking these questions and getting answers--fast. In the past, health care information spending has been like a steam train just sort of chugging along, said Patick Heim, Kaiser's chief information security officer. Now "we have a new engineer--Obama--dumping tons and tons of coal ($19 billion worth)," Heim said. "That steam train is driving faster and faster. Have we tested the rails to make sure we understand that speed? Do we have the brakes in place?"

Does spending equal efficiency?
Like most businesses in other industries, Kaiser benefits financially from efficiency. If people need less treatment because electronic records help prevent duplicate tests or enable doctors to spot issues sooner, Kaiser's bottom line gets a boost.

Most hospitals and doctors, though, get paid only when they deliver service, regardless of whether it's done efficiently. And in that environment, there's little reason to invest dollars up front in order squeeze costs out of the system over the long haul.

Nonetheless, Kaiser said it is a big supporter of what President Obama is trying to accomplish by providing financial incentives for the industry to move to digital records. It just wants to make sure that the money is spent with focus on improving care, as opposed to merely adding technology.

Although there is some debate, the consensus among medical professionals is that electronic records should be able to improve care, said Matthew Holt, the co-founder of the Health 2.0 conference and author of a well-regarded blog on health care technology. But he cautions that the speed at which the industry is moving may mean that more money is spent on older, readily available technology.

The problem, Holt said, is that many prevalent products were developed 10 or even 20 years ago. Most of the software on the market uses a traditional client-server approach, as opposed to the kind of Web-based hosted service that might make the most sense these days, Holt said.

Even companies lining up to land contracts in the digital push are urging care and caution over how the dollars are spent. Peter Neupert, head of Microsoft's Health Solutions Group, has urged the industry to put IT spending in the context of broader health care reform, saying medical records are a "necessary, but not sufficient," step.

"I'm trying to transform the discussion just a little bit," Neupert said in a January interview with CNET News. "Don't focus on spending money on tech, per se. Focus on what outcomes we want."

The outcome we want
In a perfect world, there would be a national system in which each hospital and doctor is connected. A patient would arrive at a hospital he had never visited, and all of his records would be available. That would mean that tests would not have to be repeated, and those tests that were ordered would be in the hands of doctors as soon as the results are ready. Doctors would have access not only to patient records, but also to software that provides recommended drugs and treatments. And patients would feel confident that their medical records are secure.

But even just basic digital health records could make a big difference.

Former U.S. Rep. Billy Tauzin (R-La.) said he learned that firsthand during his recent battle with cancer. For months, he was bleeding internally, and it took five trips to the emergency room and seven hospitalizations to nail down the problem.

"For six months, I had to constantly fill out the same forms," he said. "I had to go through interrogations to get the pint of blood I needed," said Tauzin, who now runs the drug industry trade group Phrma. One time, he said he found himself lying on the floor of an emergency room because he couldn't sit up as he tried to get through all the required paperwork.

Another time, Tauzin said he had an unnecessary operation because the doctor performing the surgery didn't know about an earlier procedure he had undergone--one requiring the use of longer surgical instruments than the ones the doctor had on hand.