Stanford Medicine Newsletter Updates For the Local Community

 

Plugging in to the Electronic Health Record

Information technology designed to enhance patient care and safety

   

It’s no secret that health institutions seriously lag behind other sectors of the American economy in using technology for everyday transactions. Through the economic stimulus package, the Obama administration has allocated $19.2 billion to improve health information technology. The funds will be used to upgrade patient records, promote record sharing and train people for careers in health care and health information technology.

Will the Electronic Health Record do what its supporters contend: create a new era of patient centeredness, shared decision making, better disease management and improved chronic care? Or will the EHR, as it is commonly known, lead to less efficiency, greater costs, inconsistent quality and no decline in medical malpractice suits?

David Blumenthal, MD, national coordinator for health information technology in the Obama administration, is on leave from his position as a professor of medicine and health care policy at Harvard Medical School. He was interviewed recently by Paul Costello, director of the School of Medicine’s Office of Communication & Public Affairs.

Why is it that people should care that their physician uses Electronic Health Records?

I tell them that they’re going to get better care. And I can illustrate it with stories from my own experience as a clinician using an electronic health system. It’s prevented me from giving medications that my patients were allergic to and from doing tests that were duplicative; it’s given me access to information that makes it possible to answer patients’ questions when they want the information. When I’m on call for other physicians, it gives me vital information to make better decisions in emergency situations. I don’t think you have to convince patients that this is valuable. There are some who are worried about whether the value will come along with threats to their privacy. But the value, I think, is readily apparent to most patients.

In a 2009 study by the Kaiser Family Foundation and Harvard School of Public Health, 59 percent of the respondents said that they were not confident about privacy issues. Do you believe that once EHRs are commonplace and people become comfortable with them, that number will dramatically change?

One of our major goals at the Office of the National Coordinator is to improve people’s confidence in electronic health records and the privacy and security of their information. To do that, we have to make sure that it’s easy to keep information confidential and that the people who are trusted with using electronic health systems are trained and aware of the importance of privacy and security, and also aware of the consequences of failing to protect it. So, yes, I think, when these systems become more prevalent, the emphasis on privacy and security will grow and people will become more aware of it.

I’m curious why, in your mind, health care has been such a laggard—light years behind corporate America and business in using technology in the workplace?

There are a lot of reasons for that. One is that the incentives are not lined up correctly to reward performance. People get paid just as well for delivering care that is inefficient or unsafe as they do for care that is efficient and safe. There isn’t an enormous amount of benefit to improving performance in our current health system. The money doesn’t drop to the bottom line the way it does in a business setting.

Another important reason is that electronic health records are complicated. Health care is complicated. It’s a team sport, where information is the critical aspect. The information is often fragmented and diverse, and needs to be brought together from many sources at the same time to develop a good treatment plan.

There have been numerous projections about cost savings. The RAND study of a few years ago said it would save $77 billion. The Congressional Budget Office said $33 billion over 10 years. Where do you think the savings can be achieved, and what do you now think is a realistic estimate?

I think it’s probably somewhere between those estimates. That’s a personal impression, not a scientific estimate. The savings are from reducing duplicate testing, from avoiding safety problems, from improved compliance with cost-effective care, from avoiding hospitalizations as a result of compliance with cost-effective care and from the availability of information about the use of resources. It’s very hard to manage resources if you don’t know how many resources are being used.

When you travel around the United States, what are physicians telling you? What’s on their minds?

Physicians want to take the best care they can of their patients, and they feel that there are a number of obstacles they have to overcome to do that. They have a perverse payment system, with the wrong incentives. They have an enormous number of conflicting requirements, from private insurance companies, from employers, from the government. I think what they want is simplification—a reduction in hassles, a reduction in administrative burdens, a reduction in the complexity of the payment system—and they want support in caring for patients in meaningful ways. We think that the Electronic Health Record can give them many of those benefits.

To hear a podcast of the entire interview, go to med.stanford.edu/121/2010/blumenthal.html.

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