Will Electronic Records Really Improve Health Care?

The movement toward electronic medical records is supposed to guarantee, among other things, a more secure means of storing medical data. But it doesn't always work that way, as Steve Brozak discovered in 2006.

Back then, a stolen laptop was initially believed to have exposed the personal medical record of Brozak, a former Marine, along with the medical records of many of his fellow veterans.

As the move is made to electronic medical records -- acknowledging a push by the Obama administration as part of the recent stimulus package -- a number of issues are being raised.

"In principle, this sounds pretty good, but in practice, how is it going to work?" said Brozak.

In the end, it was concluded that the medical records on the government laptop were likely never accessed. But the experience served as a warning to Brozak and others about the possibilities the electronic age brings to medical records when the wrong person gains access.

Now comes a new study from Kaiser Permanente, a nonprofit health insurer, which implemented an electronic medical records program in Hawaii in 2004. Its findings are published in the most recent issue of Health Affairs.

The study, say the authors, highlights the importance of finding new ways to deliver health care in addition to new ways of storing the information from medical practice.

Catherine Chen, the manager of national clinical systems planning and consulting for Kaiser Permanente, said that the move to electronic health records came in part because of a demand for contact with physicians in ways other than visiting the office each time they needed something from their doctor.

"We have to start thinking about different financial incentives to allow for those different modes of care," said Chen, the study's lead author.

"If you look at the financial incentives... it's really up to the private insurers to decide whether they want to reimburse for e-mailing their providers."

As for the patients, Chen noted that they seemed slightly happier with the electronic system, even with reduced doctor face time but an increase in phone calls and secure e-mails with their doctor.

"They feel like they have a better relationship with their providers because of it," she said.

While the Kaiser study of its system in Hawaii gave some reassurances about patient satisfaction, cost remained a concern and the authors of the study said it was outside their scope. They also noted that unlike most physicians, who receive fee-for-service payments, Kaiser's physicians are paid a set salary.

Skeptics have questioned the cost savings that electronic medical records are said to bring. While many have expressed that it makes intuitive sense, Dr. Caroline Lubick Goldzweig, associate chief of staff for clinical informatics at the Veterans Affairs Greater Los Angeles Healthcare System, and her colleagues expressed skepticism in a late January article in Health Affairs.

In the article, she said a lack of meaningful cost-benefit analysis "makes creating the business case for health IT adoption a challenge, and costs still remain the number-one barrier cited by all surveys assessing adoption."

Security Matters

For patients, though, the main concern about electronic medical records is their privacy -- certainly a worry that could keep many people up at night. But some say that these patients may be relieved to hear that a larger system will be more secure than what we have now.

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