Your e-health future

What you need to know about e-health records

Chuck Morton's family suffered three disruptive data breaches when its bank, its credit union, and a credit card processor were penetrated by hackers on separate occasions. The laborious process of closing and reopening accounts took them weeks.

So it's little surprise that Morton, who lives in Greensboro, N.C., and is in his late 40s, was not exactly delighted when he realized that his medical records would be computerized too.

"I don't know who has access to that information, who's selling it, who's doing what with it," Morton said. "Can you imagine someone showing up and saying, 'I'm going to extort some money out of you?'" After discussions with his physician, Morton said he's managed to keep his medical record largely offline.

If a recent federal law is as successful at promoting computerized medical records as its backers hope, Morton may become part of a shrinking minority of Americans. The stated goal of the stimulus bill that President Obama signed in February is sweeping and optimistic: "utilization of an electronic health record for each person in the United States by 2014."

To answer some common questions about electronic medical records and how they might affect you, CNET News has prepared the following list of frequently asked questions:

Q: What do people mean by electronic medical records?
A: Instead of having your medical history saved in paper files, it would be computerized and stored electronically. That promises some obvious automation benefits and could reduce mistakes such as improper medications prescribed, but it raises new questions about privacy and security. For instance, a burglar breaking into a doctor's office would be able to access hundreds of physical files, but a hacker breaking into a database could abscond with millions.

Some of the advantages of electronic medical records come only if older paper records are scanned or incorporated into the new system, a laborious and expensive process.

What are the promised benefits of electronic medical records?
Supporters say electronic medical records will boost the quality of medical care, reduce duplication of services, and limit errors, all of which could save money and lives. The National Academy of Sciences' Institute of Medicine estimates that between 44,000 and 98,000 people in the United States die each year because of errors such as being prescribed medicine to which they are allergic.

Google Health, for instance, is designed to check your prescriptions for potential interactions between your drugs, allergies, and conditions. In addition, a physician making a referral could, depending on the system, forward a patient's complete medical records with a single keystroke.

Not everyone agrees with those optimistic notions. An analysis published this year in the Health Affairs journal analyzed four years of Medicare patient data and found that electronic medical records have only a "small, positive effect on patient safety." It recommends that more evaluations be performed.

How many physicians are currently using electronic medical records?
An in-depth survey published last year in The New England Journal of Medicine found that about 4 percent of physicians have a fully functional electronic-records system and 13 percent have a basic system.

Another 34 percent had ordered one but had not installed it or planned to purchase one in the next two years. Details of these systems vary, so the fact that a physician uses an electronic system for medical records does not necessarily mean that the data can be shared with colleagues.

What form is an electronic medical record likely to take?
For physicians who are early adopters, the common practice has been to store data as an extension of their existing records on patients, sometimes called an "integrated personal health record."

The competing model, targeted at consumers, is to create a standalone personal health record, an idea that companies such as Google, Microsoft, and WebMD are supporting.

Standalone records may incorporate data from existing health care providers, and the companies behind them are hoping to convince pharmacies, lab operators, and physicians to encrypt and share data. Sometimes the existing records can be imprecise, as cancer survivor Dave deBronkart learned recently, when his Google Health record said cancer had spread to his brain or spine, thanks to not-quite-accurate billing records using codes required by insurers.

Microsoft, Google, WebMD, the American Medical Association, Aetna, Blue Cross Blue Shield Association, and others have jointly endorsed a set of guidelines for personal health records. An opinion article published in The New England Journal of Medicine in March recommends that future development focus on open standards, citing the Apple iPhone as an example of a device with a published interface for which independent software developers can create applications. One benefit of standalone records is that they're under the patient's control.

Which of these approaches is the federal government likely to back?
It's too early to tell. David Blumenthal, a former Harvard Medical School professor who has written about electronic medical records, was appointed to the post of national coordinator for health information technology in March.

Kenneth Mandl of the Children's Hospital Boston told The New York Times that it would be a bad idea to lock in the current office-based systems.

"If the government's money goes to cement the current technology in place," Mandl said, "we will have a very hard time innovating in health care reform."

Instead, as Mandl and a co-author suggested in their New England Journal of Medicine column in March, the federal government should encourage "interoperability and substitutability" similar to what Apple's online store provides to iPhone and iPod Touch customers. The key, Mandl says, is to be able to swap modules.

Why did the stimulus package that Congress enacted earlier this year push for electronic medical records?
Democrats who inserted the language in the bill defended it as a long-term investment designed to curb the rate of increase in health care costs. Sen. Patrick Leahy of Vermont predicted that "long-term cost-cutting measures, such as the use of electronic medical records, can help stimulate the health care economy and create much-needed jobs." Peter Orszag, the White House's budget director, warned last week that Medicare and Medicaid costs will spiral out of control in the next few decades, and said electronic medical records are one way to control costs.

Perhaps just as importantly, it was President Obama's chance to fulfill a campaign pledge. As a candidate, Obama incorporated electronic medical records into his campaign platform, arguing that they would save $120 billion a year, or $2,500 per family. In a town hall meeting last year, Obama said his plan would, within four years, "lower premiums by up to $2,500 for a typical family per year" by taking steps including "investing in a paperless health care system to reduce administrative costs."

Not everyone buys Obama's numbers: The nonpartisan Annenberg Public Policy Center of the University of Pennsylvania, which runs Factcheck.org, called this claim false. "We find his statements to be overly optimistic, misleading and, to some extent, contradicted by one of his own advisers," Factcheck said in a June 2008 article, in part because it's based on a study estimating cost savings that won't happen until 2019.