IN 2004, PresideNT George W. Bush set an ambitious goal for the American health-care in- dustry: by 2014, he wanted all citizens to have access to an electronic medical record (EMR). Earlier this year, President Obama reinforced the federal government’s commitment to that target, and announced that nearly $20 billion in stimulus money would be available during the next five years to help health-care providers implement digital record systems.
EMRs are widespread in Europe, Australia, and elsewhere, but only 4% of American doctors have a fully functional system, according to the New England Journal of Medicine. Another 13% use a basic one. For patients, the benefits are obvious—convenience, portability, and efficiency. EMRs also offer benefits to health-care providers, including the reduction of clerical errors and computerized decision support. And scientists are excited by the technology’s potential for furthering medical research.
For years, however, the economic incentives simply weren’t powerful enough. Although studies suggest EMRs could save billions of dollars each year, the complexity and cost of developing, implementing, and managing the technology meant that American health-care providers—most of whom work in small practices with fewer than five physicians—found little reason to adopt it. “When a physician invests in EMR, 89% of the benefit goes to someone else,” says Blackford Middleton, director of Clinical Informatics Research & Development at Partners HealthCare in Boston. Insurance companies, Middleton notes, are often the primary financial beneficiaries, saving money by streamlining the claims process and reducing duplicate tests and procedures. It’s an imbalance
the spanish Peaks Regional health center, based in Walsenburg, co, plans to make the transition to an electronic health records system before the end of 2010, which will eliminate the need for office assistants to wade through piles of paper-based patient records.
that the federal stimulus, which makes physicians eligible for up to $64,000 in incentives (and hospitals for up to $11 million) beginning in 2011, may help overcome. But EMRs also present a number of other challenges involving protocols and standards, privacy, and how physicians practice medicine.
Protocols and standards One of the main difficulties is the lack of protocols and standards. Several groups across the country have developed their own EMR systems, including Partners HealthCare, the Cleveland Clinic, and the Regenstrief Institute in Indianapolis. Hundreds of EMR vendors offer products, too. But standards for the collection, exchange, and retrieval of electronic medical information vary widely from system to
system. The Healthcare Information Technology Standards Panel (HITSP), a private-public partnership, has worked since 2005 to harmonize protocols and standards, and the Obama administration has already convened two federal advisory committees to help tackle the problem. The trick, according to industry watchers, will be finding the right balance between standardization (which helps ensure interoperability and information sharing) and flexibility (which accommodates the various systems and architectures that different health-care providers need). Britain’s National Health Service (NHS), for example, has fielded fierce criticism from clinicians about its plans to digitize the country’s health system, which are derided as rigid and inadequate.
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