E-health records not enough, experts say

Adopting electronic health records only a first step to improving US health care, say doctors

If the US$19 billion (NZ38 billion) for health IT in a recently passed US economic stimulus package goes only to driving up adoption of electronic health records, the US health care system will not improve, say some medical experts.

Not only do doctors and hospitals need to adopt electronic health records (EHRs), but those digital records need to be easy to share with patients and health care providers, said Dr. Doug Henley, executive vice president with the American Academy of Family Physicians.

And the current crop of EHRs still needs work, as doctors have to wade through multiple pages of data and enter the same information on multiple pages, added Dr. Kevin Hughes, a breast cancer surgeon at Massachusetts General Hospital. After the doctor enters the patient's health data once, the EHR should automatically populate itself with that information, he said at a health IT forum in Washington, DC, hosted by IBM and the eHealth Initiative.

"We don't have interoperability within electronic health records, much less between electronic health records," Hughes said. "A lot of the party line on electronic health records is that we need to regulate that doctors must use them ... but why don't we make them better, so they want to use them?"

The US Congress, in the stimulus package, offers grants to help health care providers convert to EHRs, but starts reducing Medicare payments to health care providers that haven't adopted EHRs by 2015.

Henley also suggested that interoperability will be an important challenge to overcome. He called on federal officials and private groups working on interoperability standards to focus on what's best for patients and what's best for primary-care doctors.

"I don't think we have a health care system in this country," he said. "We have a health care enterprise that's uniquely designed to spend a lot of money and to make a lot of money, but not to deliver on the promise of improved quality and efficiency."

In order to improve quality and efficiency, health IT needs "data liquidity," Henley added. It needs to be easy to transfer health care data among health care providers and between providers and patients, he said.

In addition, the health IT stimulus money needs to focus on small and medium-sized health care practices, Henley added. Seventy to 85% of health care in the US is delivered by those practices, he said.

"The large institutions know how to do this," Henley said. "They have the money, they've got the IT support."

IBM, while working on its own health care costs in 2005, found that a patient's personal relationship with a primary-care doctor has major advantages, added Paul Grundy, director of health care, technology and strategic initiatives for IBM's health benefits group. A patient who simply knows her primary-care doctor's name costs her employer one-third less in health care costs, has a 19% lower mortality rate, is 15% more likely to get immunisations and is 12% less likely to be obese, he said.

The way IBM was buying health care was discouraging a doctor-patient relationship, he said. "We, as buyers of care, concluded that we were the enemy," he said.

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