Electronic Health Records: The $20 Billion Prescription

By Jim Dawson

Inside Science News Service

WASHINGTON (ISNS) –The progress and problems in developing a national system of electronic medical records topped the agenda Thursday as the Obama Administration’s “best and brightest” from the world of science, medicine and technology gathered in Washington for the inaugural meeting of the President’s Council of Advisors on Science and Technology (PCAST).

David Blumenthal, the national coordinator for health information technology, said there was an “appalling lack of use of technology” in the U.S. medical record-keeping system. “Only 20 percent of physicians and 10 percent of hospitals have meaningful electronic records,” he told the 21-member panel. The transition from the paper-based medical record-keeping system to an electronic one is a priority in President Barack Obama’s push for health care reform, Blumenthal said, as a way to save money over the long run and improve the quality of health care.

In February, Obama signed the American Recovery and Reinvestment Act, which would put $20 billion toward what Blumenthal called a “completely revised, interoperable, integrated health information system.” The system, which is supposed to be functional by 2014, will actually be many different electronic records systems developed by private companies that meet a host of federal standards and requirements that are currently being developed.

“Paper records put us in a suboptimal position [to improve health care],” said Eric Lander, a co-chair of PCAST and the director of the Broad Institute, a medical genetics research program in Cambridge, Mass., run by both Harvard University and the Massachusetts Institute of Technology. An electronic records system, in addition to allowing a patient’s medical records to be shared among doctors, could allow medical researchers to “mine data and combine data” to do faster, more sophisticated medical studies, he said.

Blumenthal said the point of the system isn’t the technology itself, but how that technology is used. “There is very little about the health care system that doesn’t concern us or that we can’t affect in some way,” he said. “We are enabling information to be more accurate and available at the point of care.”

“Use” is one of three area of concern for the scientists and others developing the records system. The other areas focus on getting doctors and hospitals to adopt the electronic system, and, once they have it, how to use it to efficiently exchange information.

The “adoption” issue addresses the difficult question of “which technology should be used, which [computer] platforms are mostly likely to support innovation and change,” Blumenthal told the committee. “And we have to realize that anything that is adopted now will be primitive by the time this entire system is put into place.”

The “exchange” issue involves a host of questions and problems, he said. Should the records system be centralized? How can the system make medical records easy to study and share among doctors, but at the same time guard the privacy of patients and make them secure? “Privacy and security must be assured,” Blumenthal said.

PCAST member Eric Schmidt, the Chairman of Google, in Mountain View, Calif., asked if patients would own their electronic medical records. Aneesh Chopra, the chief technology officer at the administration’s Office of Science and Technology Policy, replied that patients would be given summaries of their records. Schmidt shook his head and said, “that isn’t the same.”

In describing ways an electronic system could benefit medical research, Chopra noted that 40 percent of the U.S. population will at some point be diagnosed with cancer, “but today less than 5 percent of cancer patients have their information in a shareable form that is suitable for research. Why can’t every cancer patient be treated like someone in a clinical trial?” he asked. With electronic medical records, they could be, he said.

John Glaser, a doctor and advisor to the national coordinator for health information technology, detailed a list of benefits in patient treatment that would come from an electronic records system. The system would allow small hospitals and medical practices to have access to patient information on a more sophisticated, interconnected level, he said.

Patients typically see several doctors and they often assume the doctors are talking to each other. They usually aren’t, he said, but with the new records system they would be. Drug interactions would be more apparent, and treatments and procedures done by one doctor could create patterns that reveal a disease like diabetes to another physician working with the records.

The trick, Blumenthal said, is “structuring the [health] market to use the system and allow for innovation, but also maintain order. And we have to assure privacy and integrity in the system. If someone is talking to their doctor about STDs (sexually transmitted diseases), they want to know their records are secure,” he said.

He concluded by noting that while Denmark and other Scandinavian countries are far ahead of the U.S. in the use of electronic records, “nobody has developed an exchange system [of electronic medical records] in a country that is anything like the U.S. in size, population, cultural value differences, and economic structure.”

“We have to live in the world we have,” he said to the scientists and others working to establish the new system.

Above article published on

http://www.aip.org/isns/reports/2009/090807_pcast.html