Schoolchildren in the United States are often threatened with an ominous-sounding "permanent record." Don't get in trouble, teachers warn, or that's where the offense will be recorded. Better do well on these tests, they'll say, because the results go in a file that will stick with you for life. It was unclear who stored the document or had access to it -- Santa Claus, perhaps? -- but while employers may ask about a criminal background or request an academic transcript, they never seem to request the permanent record.
When it comes to your health, though, it would be a big help. Known as an electronic medical record, this file would follow you from the time you were born until your dying day. Any doctor that you visited in your lifetime would immediately know what allergies you had and all the medications you'd ever taken without you having to fill out any paperwork. He or she would have access to your entire health history, and that big-picture view would help identify any changes that could cause serious problems, such as steady weight gain or continually increasing cholesterol.
The system that houses your file would also help the doctor manage your care by giving reminders of preventive screenings you should receive based on your age, gender and family history, and the system would also have the capability of issuing a warning before a mistake was made -- alerting the doctor if one of your medications reacts badly with another one. Any diagnostic lab tests that you had would be uploaded directly to the file for quick access, and if you saw a specialist, there'd be less of a chance you'd have to undergo duplicate testing. If you're battling a chronic condition like diabetes or heart disease, your doctors would be able to better coordinate your care.
Not only would this electronic medical record save you time and lead to better care, it may eventually save you and all U.S. citizens money. Analysts predict that widespread use of electronic medical records could shave tens of billions of dollars in costs from the U.S. health care system [source: Hillestad et al.]. Despite these benefits, the U.S. lags behind other developed countries in electronic medical record keeping. Find out why and learn how the system will be changing, on the next page.
Barriers to Adopting Electronic Medical Records
Though many doctors who have adopted electronic medical records report satisfaction, not many medical professionals have used the technology. According to one survey, only 15 to 20 percent of doctor's offices in the United States use electronic medical records, while just 20 to 25 percent of hospitals do [source: Hillestad et al.]. Adoption has been extremely low in small offices (one to three doctors), which is where almost 50 percent of the nation's doctors practice [source: Lohr]. Implementing electronic medical records presents particular challenges to these small offices, because the time required to switch to the new system might result in fewer patients seen, which is a loss that small practices can't easily absorb.
Once those small offices began using the technology, they'd likely have more time to see patients and may eventually increase the number of patients that doctors could see in a given day. However, this challenge is representative of most of the challenges facing widespread adoption of electronic medical records. These systems require a huge upfront cost in terms of software, hardware, training and time, and the savings that they could bring may not be seen for a few years. A doctor's office may invest thousands of dollars in the system, only to see a local hospital benefit from the office's work and financial outlay. Additionally, the true benefit of electronic medical records only comes when there are many doctors that have the technology; without a robust network, there's no one to share the information with. And it's possible that a medical practice could invest in a system, only to have all other doctors purchase another system, rendering that practice's work obsolete.
In order to help with these high upfront costs, Congress included money for conversion to electronic medical records in the 2009 stimulus bill. Doctors and hospitals may begin collecting funds to pay for their new systems, and in preparation, the Department of Health and Human Services has been issuing guidelines on which systems are acceptable and how they must be used. On the next page, we'll take a look at the money that's available and the strings that are attached.
HITECH and Meaningful Use
The part of the stimulus bill that deals with electronic medical records is known as the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH approves payments to doctors and hospitals that adopt electronic medical records; a grand total of $27 billion will be available to medical professionals over the next 10 years [source: Alonso-Zaldivar]. Each doctor could receive as much as $44,000 through Medicare and $63,750 through Medicaid to buy and implement a system [source: Pear]. Doctors and hospitals that don't integrate this technology will be subject to cuts in Medicare payments in 2015.
To qualify for the funds, medical professionals are required to use programs from vendors that are certified by the government. The certification standards were released in August 2010 and are designed to ensure that the medical records will be able to be accessed and shared throughout the country. Secondly, the medical professionals who purchase the programs must actually use them, because as we mentioned on the last page, the system won't work unless there's a widespread network of doctors participating. To ensure that patients and providers receive the maximum benefit from the government's investment, the Department of Health and Human Services (HHS) has released meaningful use standards. Doctors and hospitals must meet these standards in order to qualify for their incentive payments.
The meaningful use standards were developed with input from medical professionals. For example, HHS originally set forth 23 objectives for hospitals and 25 for doctor's offices. After receiving feedback that these guidelines would be too difficult to meet in one or two years, the standards changed. Now, there's a set of 15 core objectives that medical professionals seeking incentives must meet. These objectives include recording patient demographics, recording vital signs and chart changes, and ordering prescriptions via the electronic system. In addition, there's a separate menu of 10 activities, of which doctors must choose five to implement -- transferring patients' records in the event that they switch doctors, for example.
The objectives are designed to get medical professionals comfortable with the new technology while moving them toward the level of activity they'll need to reach to make the system truly effective. And while the system vendor should provide training on how to perform these tasks, the government is sponsoring regional health IT extension centers to those professionals that need a little more help with the technology.
To learn about other changes that may be coming to your doctor's office soon, see the links on the next page.
- Alonso-Zaldivar, Ricardo. "Ambitious timetable for electronic medical records." Associated Press. July 13, 2010. (Aug. 9, 2010)http://www.physorg.com/news198256864.html
- Blumenthal, David and Marilyn Tavenner. "The 'Meaningful Use' Regulation for Electronic Health Records." The New England Journal of Medicine. Aug. 5, 2010. (Aug. 9, 2010)http://healthpolicyandreform.nejm.org/?p=3732
- BMJ - British Medical Journal. "Electronic Medical Records Could Be Used As A Predictor of Domestic Abuse." ScienceDaily. Sept. 30, 2009. (Aug. 9, 2010)http://www.sciencedaily.com /releases/2009/09/090929194203.htm
- "Evidence on the Costs and Benefits of Health Information Technology." Congressional Budget Office. July 24, 2008. (Aug. 9, 2010)http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml
- Freudenheim, Milt. "As Medical Charts Go Electronic, Rural Doctor Sees Healthy Change." New York Times. April 11, 2009. (Aug. 9, 2010)http://www.nytimes.com/2009/04/11/technology/11records.html
- Garets, Dave and Mike Davis. "Electronic Patient Records." Healthcare Informatics Online. October 2005. (Aug. 9, 2010)http://www.providersedge.com/ehdocs/ehr_articles/Electronic_Patient_Records-EMRs_and_EHRs.pdf
- Hillestad, Richard, James Bigelow, Anthony Bower, Federico Girosi, Robin Meili, Richard Scoville, and Roger Taylor. "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings and Costs." Health Affairs. September/October 2005. (Aug. 9, 2010)http://www.eecs.harvard.edu/cs199r/readings/RAND_benefits.pdf
- Lohr, Steve. "How to Make Electronic Medical Records a Reality." New York Times. March 1, 2009. (Aug. 9, 2010)http://www.nytimes.com/2009/03/01/business/01unbox.html
- Lohr, Steve. "Little Benefit Seen, So Far, in Electronic Patient Records." New York Times. Nov. 16, 2009. (Aug. 9, 2010)http://www.nytimes.com/2009/11/16/business/16records.html
- Lohr, Steve. "Most Doctors Aren't Using Electronic Health Records." New York Times. June 19, 2008. (Aug. 9, 2010)http://www.nytimes.com/2008/06/19/technology/19patient.html
- Lohr, Steve. "Tech Companies Push to Digitize Patients' Records." New York Times. Sept. 10, 2009. (Aug. 9, 2010)http://www.nytimes.com/2009/09/10/technology/10records.html
- Mann, Denise. "Technology Plays Key Role in Health Care Reform." WebMD. (Aug. 9, 2010)http://www.webmd.com/healthy-aging/features/technology-plays-key-role-in-health-care-reform
- Pear, Robert. "Doctors and Hospitals Say Goals on Computerized Records are Unrealistic." New York Times. June 7, 2010. (Aug. 9, 2010)http://www.nytimes.com/2010/06/08/health/policy/08health.html
- Pear, Robert. "Privacy Issue Complicates Push to Link Medical Data." New York Times. Jan. 18, 2009. (Aug. 9, 2010)http://www.nytimes.com/2009/01/18/us/politics/18health.html
- Pear, Robert. "Standards Issued for Electronic Health Records." New York Times. July 13, 2010. (Aug. 9, 2010)http://www.nytimes.com/2010/07/14/health/policy/14health.html
- "Secretary Sebelius Announces Final Rules to Support 'Meaningful Use' of Electronic Health Records." Department of Health and Human Services. July 13, 2010. (Aug. 9, 2010)http://www.hhs.gov/news/press/2010pres/07/20100713a.html
- Singer, Emily. "A Digital Health-Care Revolution." Technology Review. Jan. 28, 2009. (Aug. 9, 2010)http://www.technologyreview.com/biomedicine/22026/
- University of Texas Health Science Center at Houston. "New Recommendations Can Help Health Providers Prepare for Electronic Record Push." ScienceDaily. Sept. 8, 2009. (Aug. 9, 2010)http://www.sciencedaily.com /releases/2009/09/090908193440.htm