Obstacles remain for electronic records

Scripps Howard

The prospect of going paperless in health care is a little bit like thinking about going to heaven — it sounds like a great goal, but the details of how you get there are daunting.

For many years, health-care reformers of every stripe have insisted that whatever they wanted to do with the system would bring down administrative costs — usually estimated to account for 10 percent to 20 percent of all medical expenses.

Along with administrative simplicity, few fixes have been touted as much as the electronic health record, also known as the personal health record, the digital health record or, lately, health information technology. President Bill Clinton said in 1994 they would be in every doctor’s office in 10 years; President George W. Bush said the same in 2004.

Health IT heaven is a system that provides the most up-to-date, accurate information about each individual to any health provider who needs it, but keeps charts private from everyone else.

At the same time, all of this is integrated with systems that electronically prescribe medicines, tests and other procedures, code everything for bill purposes and boost efficiency and quality.

Something close to the ideal has been set up in health systems and physician practices in a few places around the country. And there have been more than a few studies done that show effective use of health IT can save lives, reduce complications and lower costs.

But there also have been studies that show little impact on quality or cost from using electronic systems.

And the recent disclosure that nearly a third of the medical records systems used in VA health centers around the country had glitches that produced false information and led, for some, to improper or delayed treatment over a five-month period last year, illustrates the potential for failures.

A survey published last summer in The New England Journal of Medicine found that just 4 percent of doctors nationwide are using full-scale electronic records and prescribing systems in their offices.

Likewise, many hospitals have electronic record-keeping, but relatively few have a single system in use across all departments and only a handful extend into doctors’ offices or other providers. Virtually none of the systems is readily accessible to patients or doctors outside the institution.

There have been strides in setting standards for electronic exchange of health data, but the technical options are still more complex than deciding on what type of digital movie player to buy.

Lots of software programs and entrepreneurs offer to encode patient data on a chip, a bracelet, a flash drive or even your cell phone. But it’s up to you, the patient, to keep the information current. And even if a doctor is willing to treat your virus, many are reluctant to expose their computer systems to a possible cyber virus.

Some health insurers are offering patients Web-based personal health histories, but these tend to lack the clinical details health providers want. Internet big guns like Google and Microsoft have been working to create giant platforms that would store records and make them accessible to everyone with a password, but there are privacy worries for this approach, too.

The biggest obstacle to digital records has been that the health-care industry in general and doctors in particular are reluctant to invest in new technology that seems to offer mostly intangible benefits.

The latest Democratic economic stimulus plans would pour between $5 billion and $20 billion into information upgrades for health, mostly in physician offices and clinics. As a candidate, President Barack Obama talked about spending as much as $50 billion on the technology.