[LINK] Electronic Medical Records

[stephen at melbpc.org.au]

How to Make Electronic Medical Records a Reality 

By STEVE LOHR mytimes.com Published: February 28, 2009 

IN the world of technology, inventors are hailed as heroes. Yet it is 
more subtle forms of innovation that typically determine the impact of a 
technology in the marketplace and on society. 

Clever engineering, smart business models and favorable economics are the 
key ingredients of widespread adoption and commercial success.

History abounds with evidence. For years, much of what was known 
as “Yankee ingenuity” was, in fact, the American ability to pursue 
commercial applications of British inventions, from the Bessemer steel 
process to the jet engine. 

Even in computing, which we regard as made-in-America technology, the 
first stored-program computer, simple programming language and reusable 
code were pioneered in Britain. 

But, of course, computer technology and the industry really flowered in 
the United States. That happened in no small part because the federal 
government nurtured the market with heavy investment, mainly by the 
Defense Department, and by choosing standards, like the Cobol programming 
language.

Today, Washington is about to embark on another ambitious government-
guided effort to jump-start a market — in electronic health records. 

The program provides a textbook look at the economic and engineering 
challenges of technology adoption.

In its economic recovery package, the Obama administration plans to spend 
$19 billion to accelerate the use of computerized medical records in 
doctors’ offices. Medical experts agree that electronic patient records, 
when used wisely, can help curb costs and improve care. 

The proof is seen in large medical groups, with hundreds or thousands of 
physicians. They sift, sort and analyze the data from digital records, 
for example, to better manage the health of patients with costly, chronic 
conditions like diabetes and heart disease. These larger groups have the 
scale to invest in information technology, and they are often insurers as 
well as providers, so they benefit directly from the cost savings.

Yet these large groups are the exceptions in American health care. 

Three-fourths of the nation’s doctors practice in small offices, with 10 
doctors or fewer. For most of them, an investment in digital health 
records looks like a cost for which they are not reimbursed. 

It is scarcely surprising, then, that only about 17 percent of the 
nation’s physicians are using computerized patient records, according to 
a government-sponsored survey published last year in The New England 
Journal of Medicine.

“This is really not a technology problem,” observed Erik Brynjolfsson, an 
economist at the Sloan School of Management at the Massachusetts 
Institute of Technology. “It’s a matter of incentives and market failure.”

That market failure is a principal target of the Obama administration’s 
plan. 

A main feature of the legislation calls for incentive payments of more 
than $40,000 spread over a few years for a physician who buys and uses 
electronic health records. But the technology is just a tool, one that 
needs to be used properly to improve health care.

So the legislation states that physicians will be paid only for 
the “meaningful use” of digital records. 

The government has not yet defined that term precisely. While the long-
term goal is better health for patients, that can take years to measure. 

Consequently, many health experts predict that the meaningful use will be 
a requirement to collect and report measurements that can be closely 
correlated with improved health. Examples would be data for blood 
glucose, cholesterol and blood pressure levels for diabetes patients.

The legislation, health experts say, seems thoughtfully put together, but 
the obstacles to success will be daunting. 

“What’s underappreciated is the implementation challenge,” said Dr. 
Blackford Middleton, chairman of the Center for Information Technology 
Leadership, a research arm of Partners Healthcare in Boston.

A crucial bridge to success, according to experts, will be how local 
organizations help doctors in small offices adopt and use electronic 
records. 

The new legislation calls for creation of “regional health I.T. extension 
centers.” In a letter to the White House and Congress last month, Dr. 
Middleton and 50 other experts emphasized the importance of these centers 
and pointed to the Primary Care Information Project in New York City as a 
model.

The New York project’s brief history, beginning two years ago with $27 
million in financing, offers a glimpse of the challenges of wiring small 
physician practices. 

The New York team, headed by Dr. Farzad Mostashari, an assistant 
commissioner in the city’s health department, started by bringing in 
decision-support experts in medicine to study how doctors work, so the 
technology would be easier to use. Team members considered writing their 
own software for simple, Web-based electronic health records, but 
abandoned that idea once they understood that patient records would have 
to be tightly linked to billing — a physician’s financial lifeblood. 

The project’s 50-member staff provides centralized technical support and 
education for doctors and others. “There’s no way small practices can 
effectively implement electronic health records on their own,” Dr. 
Mostashari said. “This is not the iPhone.”

The staff worked closely with its software supplier, eClinicalWorks, to 
tweak and tailor the system. They began rolling out the records a little 
more than a year ago. They are now used by more than 1,000 physicians, 
mainly in poorer neighborhoods, whose workplaces include two hospital 
outpatient clinics, 10 community health centers, 150 small group 
physician practices and one women’s jail, serving a total of one million 
patients. 

The rollout is progressing, and the government plan promises to 
accelerate adoption.

“Our experience here is that it’s just hard,” Dr. Mostashari said. “It’s 
not impossible.” 

http://www.nytimes.com/2009/03/01/business/01unbox.html?_r=1&th&emc=th

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Cheers,
Stephen