In the latest step toward the computerization of Americans' medical information, President-elect Barack Obama said in a speech Thursday that the government will push for electronic health records for all Americans within five years in order to save both dollars and lives.
"To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized," Obama said in a speech from George Mason University in Fairfax, Va. "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests."
"But it just won't save billions of dollars and thousands of jobs; it will save lives by reducing the deadly but preventable medical errors that pervade our health-care system," he said.
Electronic health records systems are systems employed by hospitals, insurance companies and other medical institutions to keep track of patient information. While the development of the systems is still in its infancy, some medical centers such as those run by Group Health Cooperative and Kaiser Permanente use them to keep track of patients.
Dr. Bill Crounse, senior director of worldwide health for the Microsoft Corporation, said that he is "thrilled that President-elect Barack Obama is stepping forward to carry the torch" with regard to the development of electronic medical records for all Americans.
"The opportunity here is so much bigger than just electronic medical records," he said. "The opportunity is really to think in entirely new ways about how you do health care."
Microsoft could well be one of the major players in the eventual development of such a system. The company launched a beta program of an online medical records program called Healthvault in 2007. The company now has partnered with Kaiser, the American Heart Association, the Cleveland Clinic and others in creating a user-accessible program and laying an infrastructure for others to build upon.
But the plan for a wholesale switch to electronic medical records may have a number of hurdles to clear before it sees the light of day.
"In 2004, President Bush proclaimed that we would have electronic medical records for most Americans within 10 years ... and the government did make some investments," Crounse said. "Here we are five years later, and I think the needle has moved slightly."
Even the definition of what makes up "electronic health records" is still a matter of some debate. While electronic systems could conceivably allow doctors to order tests, send prescriptions and keep track of every detail of an individual's medical history, some organizations have a very loose definition of what an electronic health record is. Procedures as rudimentary as electronic medical billing, for example, are assumed by some to fit the bill.
"Electronic medical records could constitute anything from something as simple as the note that contains a doctor's decisions to the underlying data that led to those decisions," said Rob Webb, CEO of OptumHealth Care Solutions,another company that is looking for opportunities to develop electronic medical records technologies.
But many doctors have been reticent to even adopt the technology that is currently available. In a 2008 article published in the New England Journal of Medicine, researchers led by Dr. Catherine DesRoches of Harvard Medical School found that 17 percent of doctors currently use electronic medical records.
One significant barrier to attaining a universal electronic health records system could be cost. Physicians may be required to foot a bill of tens and thousands of dollars to invest in such a system for their offices, not to mention steep annual maintenance fees.
For larger practices with more physicians, the additional cost may not pose much of a problem. But for an office with fewer than 10 or so physicians, electronic medical records may seem impractical and expensive.
"I think the primary issue is cost, specifically capital investment, as well as decreased productivity during the changeover," said Dr. Thomas Schwenk, chairman of family medicine at the University of Michigan. "It is estimated to take many months, possibly even a year, to get back to previous level of productivity in the office when switching from paper to [electronic medical records]."
The learning curve is another issue.
"There is a well-known lack of skilled personnel to properly implement and sustain these systems, and that experience does not come easily," said Dr. Lyle Berkowitz, medical director of clinical information systems at the Northwestern Memorial Physicians Group in Chicago.
Berkowitz argued that physicians are not sufficiently reimbursed for the time, energy and money required to adopt an electronic medical records system. The known benefits of switching to an electronic system -- such as less duplication of tests and more preventive care -- are enjoyed primarily by insurance companies, patients and employers rather than physicians, he said.
"In other words, to implement ... an EMR effectively, a physician will likely lose money and not get reimbursed for more effective or higher quality of care," Berkowitz said.
Crounse said that it is little surprise that few doctors -- particularly primary care doctors -- are stepping forward to invest what he says could be $25,000 in a system for electronic medical records.
"We're asking them to step up and spend a lot of money on electronic medical records. The doctors will say that a lot of the benefits of these systems accrue to everyone but the doctor."
While he said that the benefits for doctors are there -- primarily in the form of improved patient safety and care -- this perception could give many doctors pause.
With the novelty of electronic health records also comes new questions about how to keep the information private and secure. Particularly concerning to some is that many of the records may be stored on the Internet.
The architects of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) -- more or less the law of the land when it comes to patient privacy -- did not anticipate Web-based health record systems so they have nothing in their act that regulates Web data handling and patient privacy.
The privacy issue becomes even more questionable with the introduction of personal health records -- in short, a do-it-yourself approach to keeping track of your medical care. Google, Microsoft and a consortium of large employers known as Dossia Founders Group are just a few of the big Internet names that have begun to allow patients to create and maintain their records online.
Personal health records may be the key to allowing patients to get the most out of electronic medical records. Ideally, Crounse and Webb both noted, these records would let patients manage their medical particulars in much the same way as they manage their financial matters online.
Advocates add that online personal health records can help eliminate redundant tests, better prepare doctors to see patients and result in better-informed patients.
However, critics note that these records are not yet subject to the privacy standards set forth by HIPAA. And although the companies that maintain personal health records promise privacy, one cannot be 100 percent sure if their rights are being abused or how their information is being even used.
Privacy advocates worry mainly about data-mining. And individuals may not even have absolute control over their personal health information. Consider, for example, this clause in Google Health terms and services that applies to personal health records maintained with the company:
The clause goes on to reiterate that Google is not a "covered entity" when it comes to HIPAA privacy regulations.
Still, despite these considerations, proponents of electronic medical records maintain that as technology continues to improve, the use of these resources will become routine for most people.
"I believe that within the last couple of years, health-care information technology has really been able to offer solutions that we can use in this effort," Crounse said.
And Webb added that considering the current state of the country's health-care system, the time is ripe for change -- and government finds toward this effort would be money well spent.
"This is a $200 million to $300 million investment to help a $2.3 trillion part of our economy work better," he said.