Tuesday, January 13, 2009

Health Care and Digitized Medical Records

Now there is a big push to digitize all health records. According to CNNMoney.com, President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic. Here's the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline. Sounds good. But it won't be easy. In fact, many hurdles stand in the way. Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.

As reported by CNNMoney, it also won't come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program. That's a huge amount of money -- since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan. The biggest cost will be paying and training the labor force needed to create the network. But highly skilled health information technology professionals are as rare as they come, and many IT workers will need to be trained as health technology experts. Early government estimates showed about 212,000 jobs could be created from this program, but there simply aren't that many Americans who are qualified. Furthermore, ensuring the privacy of patients' records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law.

The savings of such a plan could be substantial. The CNNMoney report estimates that a fully computerized health record system could save the industry $200 billion to $300 billion a year.
That could ultimately slow the rapid rise of health care premiums, which have cut into Americans' paychecks. While wages are rising at a rate of around 3% a year, health care costs are growing at about three times that rate. Some say some of the hard work has begun. The Bush administration laid much of the groundwork for the program, leading to several pilot programs in a handful of states, as well as a standardization of medical records.

The State of Kentucky is moving forward with a plan to put the commonwealth at the top of the heap for health-care information technology, according to Cincinnati.com. Health-care providers have been reluctant to embrace IT on a large scale because there are no data to show it works. And, Kentucky ranks near the top nationally for heart disease, diabetes, obesity and a number of other ailments. But Kentucky is ready to take on the task by creating a statewide database of its 4 million residents. Implementing the technology on a statewide basis should cost about $500 million. The University of Kentucky and University of Louisville would manage data regarding patients' health status and outcomes. Upgrading the whole state should save money and reduce medical errors; and using electronic medical records, patient barcodes and wireless medical devices that check blood sugar or blood pressure and monitor prescription drug usage should help make patients healthier. The project should also generate jobs and new businesses in the state.

According to CNET News, some hospitals and medical offices, of course, are already wired, but right now, most people aren't able to view their records electronically. Naturally, companies like Microsoft have been plotting ways to fill that void. At least one recent study found security and privacy vulnerabilities remain as e-health advocates forge ahead with their plans. And, according to MLive.com, health care providers across the state of Michigan and the country are spending money on records software, but their systems are different, and much of the data still comes on paper. Patients see many different providers. The network aims to create a system to allow the information to flow. Advocates of the technology say its broad use can improve quality, reduce medical errors and care costs, improve administrative efficiency and reduce paperwork. And, SFGate.com reported that the slow shift of the American health industry from paper to digitized records has been fraught with complications, a major one being that hospitals, medical groups and insurance companies typically have closed computer systems that do not allow for the exchange of information.

ABCNews.com reports that even the definition of what makes up "electronic health records" is still a matter of some debate. While electronic systems could conceivably allow doctors to order tests, send prescriptions and keep track of every detail of an individual's medical history, some organizations have a very loose definition of what an electronic health record is. Procedures as rudimentary as electronic medical billing, for example, are assumed by some to fit the bill. One significant barrier to attaining a universal electronic health records system could be cost. And, physicians may be required to foot a bill of tens and thousands of dollars to invest in such a system for their offices, not to mention steep annual maintenance fees. For larger practices with more physicians, the additional cost may not pose much of a problem. But for an office with fewer than 10 or so physicians, electronic medical records may seem impractical and expensive.

According to ABCNews.com, with the novelty of electronic health records also comes new questions about how to keep the information private and secure. Particularly concerning to some is that many of the records may be stored on the Internet. The architects of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) -- more or less the law of the land when it comes to patient privacy -- did not anticipate Web-based health record systems so they have nothing in their act that regulates Web data handling and patient privacy. The privacy issue becomes even more questionable with the introduction of personal health records -- in short, a do-it-yourself approach to keeping track of your medical care. Google, Microsoft and a consortium of large employers known as Dossia Founders Group are just a few of the big Internet names that have begun to allow patients to create and maintain their records online.

According to ABCNews.com, advocates add that online personal health records can help eliminate redundant tests, better prepare doctors to see patients and result in better-informed patients. However, critics note that these records are not yet subject to the privacy standards set forth by HIPAA. And although the companies that maintain personal health records promise privacy, one cannot be 100% sure if their rights are being abused or how their information is being even used. Privacy advocates worry mainly about data-mining. And individuals may not even have absolute control over their personal health information. Consider, for example, this clause in Google Health terms and services that applies to personal health records maintained with the company: "When you provide your information through Google Health, you give Google a license to use and distribute it in connection with Google Health and other Google services. However, Google may only use health information you provide as permitted by the Google Health Privacy Policy, your Sharing Authorization, and applicable law." The clause goes on to reiterate that Google is not a "covered entity" when it comes to HIPAA privacy regulations.

The new administration will have its hands full with lots of activities after the inauguration. Let's hope that the priorities of national security, the economy, and health care are effectively managed in order of importance.

Until next time. Let me know what you think.

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