Electronic Health Records — A Key to Progress

Electronic health records are a key to the advancement of the healthcare system.  Having medical records that follow patients across the continuum of care will enhance outcomes as all providers share a complete set of data.  Also, fully shared data will help reduce costs by eliminating redundant diagnostic evaluations and unnecessary prescribing of medications.  Electronic health records will facilitate the development of new models of care, such as the patient centered medical home.

However, only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records according to Kathleen Sebelius, secretary of health and human services.

As reported by the New York Times yesterday (http://www.nytimes.com/2010/07/14/health/policy/14health.html?_r=1&hpw), the federal government issued new rules Tuesday that will reward doctors and hospitals for the “meaningful use” of electronic health records, a top goal of President Obama.  The rules significantly scale back proposed requirements that the health care industry had denounced as unrealistic.

The main criticism of the rules proposed by the Obama administration in January was that they took an “all or nothing” approach. Doctors could not have received any federal bonus payments unless they met 25 criteria, or objectives, and hospitals would have been required to meet 23.

Standards in the new rules are less demanding and more flexible. Doctors will have to meet 15 specific requirements, plus 5 chosen from a list of 10 objectives. Hospitals will have to meet 14 requirements, plus 5 chosen from a menu of 10 goals.

Doctors, for example, will have to use electronic systems to record patients’ demographic data (sex, race, date of birth); their height, weight and blood pressure; their medications; and their smoking behavior.

To meet the new standards, doctors will have to transmit 40 percent of prescriptions electronically. Under the proposal, 75 percent of prescriptions had to be sent electronically.

The Department of Health and Human Services said doctors and hospitals could receive as much as $27 billion over the next 10 years to buy equipment to computerize patients’ medical records. A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size.

Sometimes, small steps are better than no steps at all.  Moving physicians and other providers to communicate with each other at all sometimes seems a big enough challenge to patients.  Anything that helps a patient not have to repeat the same story to each physician is a significant accomplishment.  Therefore, not only will the system reduce costs and improve the quality of care, patients will have fewer headaches just from accessing the system.

A few years ago, I was speaking with a leading researcher at the Commonwealth Fund.  He suggested that it might take 20 years to implement a fully-functioning electronic health record.  With the current administration’s financial support and guidelines for the initiative, we might achieve that goal in that timeframe.  However, a great deal can be accomplished through the “baby steps” proposed under the relaxed guidelines. 

For example, entering demographics and utilizing e-prescribing allows basic checks of appropriateness of the prescription.  It also reduces the opportunity for over-prescribing or duplicate prescribing of pain killers and other potentially abused medications.

The final rules do not guarantee that doctors and hospitals can electronically exchange clinical information on patients. The rules do require health care providers to work toward that goal, widely seen as a way to improve the coordination of care and avoid the duplication of tests. 

Of course, this is where the rubber meets the road.  Enhancing longitudinal and intra-practice communication is a significant step forward.  Using electronic health records to compare prescribing and treatment patterns to generally-accepted practice standards and algorithms will help improve the quality of care.  But a significantly increased return on investment will occur when the systems can communicate throughout the continuum of care.  The next step is for the healthcare and information technology communities to set data layout standards that will make this possible. 

Co-operation?!  What a novel concept!

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