Technology must play a central role for proposed health care reform to contain costs, improve access, and save lives. A smart, ubiquitous electronic medical record system is certainly a big part of the package, but will we have to sacrifice our privacy to reach these lofty goals?
“A key part of health care reform involves the use of technology to address a number of issues such as access, value, and cost,” says former Sen. Bill Frist, R-Tenn., a former heart-lung transplant surgeon. He made his comments at the General Electric Healthymagination conference in New York City.
But what exactly is all the hype about?
Electronic Medical Records: The Promise
An electronic medical record is a digital and portable version of the current paper file system that would be accessible to all doctors. That means that whenever you see a new physician, you could stop filling out endless paper forms, as your doctor could access everything about you on the computer.
"Imagine a world where everything important about a patient is known to the physician the first time that patient presents,” says Andrew Rubin, vice president for NYU Medical Center Clinical Affairs and Affiliates in New York City. Rubin says it isn’t about finding out your medical “secrets,” but about sharing important information with doctors who may not know your history.
“No one doctor currently has complete cradle to grave medical records and a lot of things fall through the cracks as a result,” says Marie Savard, MD, a clinical associate professor of internal medicine at the University of Pennsylvania in Philadelphia, and author of How to Save Your Own Life.
“We know that the ability to make a diagnosis is based more on medical records and your history than blood work and an exam.”
“Having your lifelong history right there will actually assure that the diagnosis is more accurate and fewer mistakes will get made,” Savard says.
But “an electronic medical record is only as good as its availability,” she says. “All these benefits are only possible if the information is in an open network and everyone with permission has unfettered access,” she says.
Rubin agrees: “We need to be able to implement an electronic medical record where physicians can talk to each other about patients, and hospitals and physicians can communicate back and forth and share critical information on tests done and previous diagnoses, so that everyone involved has the patient’s medical history at their fingertips,”
This will ultimately save money by reducing unnecessary, repeat tests, and cutting back on the time it takes to make diagnosis, Rubin says.
But it also opens a whole new can of worms.
EMR: The privacy pitfall
It’s one thing to have your financial information online, but your health information is another story altogether. Many people have real fears about what could happen if their medical records fell into the wrong hands.
The benefits of EMRs are real, but so too are the barriers, Savard says. “Health care information is the most private and the safeguards can’t be strong enough, and we may not ever get over this barrier.”
The fear factor is two-fold: general Internet security and confidentiality,says C. Martin Harris, MD, the chief information officer at the Cleveland Clinic in Ohio.
“Most people are really expecting the organization to manage technical security such as the threat of hacker,” he says. On this front, the fears – and their antidotes -- are among the same as they are for doing your Christmas shopping with a credit card.
“The differential is really related to confidentiality of medical records,” he says. The fear is that someone, say an insurance carrier, could get access to information, and use it against you.
Although you can’t prevent such a breach, certain safety nets may make it less enticing to any and all potential voyeurs. “Audit trails in some systems can tell you who looked at your records, when they looked and what page they looked at,” Harris says. This may be a major disincentive.
Any safety net will be put through the ringer if a universal electronic medical record is developed and implemented, Rubin says.
EMR: Who should foot the bill?
Privacy issue is one major barrier, but cost is the other. Ashish Jha, an associate professor of health policy and management at Harvard School of Public Health, estimates that it could cost anywhere from $20 million to $200 million per hospital over several years to put these systems in place. It would cost one doctor’s office about $50,000.
Currently, fewer than 10% of U.S. hospitals are using electronic medical records in a basic way, he found.
Other studies have estimated the overall cost at $75 billion to $100 billion over 10 years.
“The costs are astronomical,” Savard says.
President Obama is hoping to offset these costs by offering a total of $20 million in stimulus funds to hospitals and doctors who exhibit a “meaningful use” of electronic medical records by 2011. Meaningful use implies that health care providers use a electronic medical record, exchange data and submit information to the government on clinical quality measures.
“The stimulus bill tends to take the direct costs off of physicians, but it’s a reimbursement model, so doctors need to first make an investment and use the system properly to get their money back,” Harris says.