Digital Health Records Debate

Push for digital health records sparks debate

By Mimi Hall, USA TODAY
WASHINGTON — The blank wall behind the receptionists' desk stands as a symbol of efficiency in Peter Basch's bustling office. A dozen years ago, Basch and his fellow doctors went paperless and ditched the stacks of patients' charts that stood there.
An early entry into the world of electronic medical records, Basch is an enthusiastic supporter. "It allows our staff and physicians to be far more organized," he says. And that means "more focused on the patient."

President Obama wants doctors' offices and hospitals nationwide to follow suit, and the government has set a goal for every American to have an electronic health record by 2014.

Kathleen Sebelius, the White House nominee for Health and Human Services secretary, calls the move to computerization "one of the linchpins" of overhauling the nation's health care system. Obama casts it as a factor in the nation's economic recovery, saying going paperless would "save billions of dollars and thousands of jobs."

Naysayers suggest health information technology (IT), the overall move to computerization, is full of false promise. Digital records can lead to better care and fewer medical mistakes, they say, but the costly transformation could waste money if the doctors and hospitals buy systems that can't be connected to share information.

"We could head for a techno-Katrina," warns Sen. Barbara Mikulski, D-Md., referring to the government's failed efforts to respond to the 2005 hurricane. "I do not want to do that, where we do a dollar dump, and at the end of the day, we have a lot of microchips floating around."

Costs of an upgrade

Studies published in The New England Journal of Medicine show that less than 2% of hospitals use electronic records in all departments and that 17% of doctors have functioning digital systems.

The Obama administration says the government could save $12 billion over 10 years if doctors go digital because electronic systems help reduce duplication of tests, prevent medical errors and prompt doctors to prescribe less-expensive drugs. "We are confident that health IT will significantly bring down the cost of health care and benefit all Americans," says Nick Papas, a Health and Human Services spokesman.

In February, as part of the $800 billion economic stimulus package, Congress approved $19.5 billion to jump-start health care's digital revolution by providing incentives to doctors and hospitals that take Medicare and Medicaid patients — which 90% do. The federal government plans to set up regional centers, staffed by "geek squads," to help offices get their systems up and running, and those who don't take steps to go digital will face graduated penalties beginning in 2015.

Obama tapped Harvard Medical School professor David Blumenthal to oversee progress.

Questions about the effort are being raised by health care experts.

Avalere Health, a research company for government and industry, released a study last month showing that it will cost the average doctor or small medical practice about $124,000 to upgrade to computers over the period that the government incentives are offered, 2011-15. Those incentives, the study said, would add up to $44,000 per office at best.

Blumenthal co-wrote a study in March that raised similar concerns about the investments needed to buy and maintain the systems.

"There's not much reason to believe that this is going to save significant amounts of money," says Jonathan Oberlander, a University of North Carolina School of Medicine professor.

Push for protections

Basch's seven-doctor practice went digital when it was bought by MedStar Health, so the doctors didn't have to pay for the switch. The office then saved money by going from 3½ staffers per doctor to two. Each of the examining rooms has a large computer screen so doctors and patients can look at records together. If a new drug would interact badly with one the patient is already on, the system lets the doctor know.

As part of MedStar, the office is connected to 500-600 area doctors, several hospitals and labs.

Those kinds of connections raise concerns among privacy rights advocates. Strict new protections, including a ban on the sale of personal health information, were included in the stimulus bill. It's too early to tell how well they will be enforced.

Last week, Kaiser Permanente announced it had fired 15 hospital workers for snooping in the electronic health file of Nadya Suleman, the octuplets' mom.

Without proper protections, health IT could end up harming patients, says Ashley Katz of the group Patient Privacy Rights. If patients don't feel certain their records are protected from employers, creditors and marketers, they may not tell their doctors the truth about certain conditions or behaviors, she says. "The more data you have out there, the more good things you can do," Katz says. "But also, the more bad things."