Opinion, arguments & analyses from the editors of Scientific American

Moving forward with electronic health records


electronic health records stimulus progressNEW YORK—Almost a year since President Obama signed the American Recovery and Reinvestment Act (ARRA), which earmarked some $19 billion to get electronic health records off the ground, most of the country's medical and research institutions are still primarily pushing paper.

So what will it take to help medical institutions get a move on?

Researchers, health professionals and government officials gathered here today at the New York Academy of Sciences to try to hash that out. Bells, whistles and some financial carrots seemed to be the most popular ideas, but many in the field cautioned that the onslaught of information is set to create a fundamental shift in medical practice and research.

Many of the promised benefits of electronic health care records are in eliminating redundant boxes in drab workflow charts, reducing errors and cutting costs. But some of the sexier possibilities include leveraging the wealth of health info to help physicians and other health care workers make better decisions in real-time.

A new wide-ranging repository of data could help, for instance, with diagnostic decisions. As Charles Lagor, of Philips Research North America, noted at the symposium, one program being worked on there would allow radiologists, who are tasked with poring over countless images, to sync a new patient's history with stored data on patients with similar histories to come up with a probability level for diagnoses. The algorithms in this case-based reasoning program, said Lagor, have had more than 90 percent accuracy so far. By helping care providers make more informed on-the-spot decisions, Lagor—and others working on developing new systems—hope to meet the government's criteria for ARRA funds by proving their projects will have "meaningful use."

The deluge of e-records data, however, could sink systems and providers unprepared to deal with it. Electronic medical record systems need not just be digital versions of paper files, noted John Gomez, of Eclipsys Corporation, a health IT provider; they ought to have the smarts to organize and optimize the information. Doctors, too, will likely become responsible for taking all this additional information into account and in the future might be found liable if they neglect to do so.

Much more mobile information also means more security concerns, especially for the institutions with the electronic systems that could be held financially liable for breaches in security—accidental or intentional. A new set of rules from the Health Insurance Portability and Accountability Act (HIPAA) set in place September 2009 requires institutions to provide information to patients (if they request it) about who has seen their medical records not just in the event of an unusual breach as was previously the practice, but also anyone who accesses it for standard treatment, payment or operations—a huge increase in reporting and accountability demands, noted Soumitra Sengupta of Columbia University and New York Presbyterian Hospital.

On the up side, as with the digitization of other fields, in everything from recipes to stock trading, putting content into the ether has historically had a way of democratizing it. Health records may well follow this trend, according to many who propose that the future guardians of health records will be individuals themselves.

Records that now live shrouded in opaque manila folders and locked in hospital basements might soon be just as open to the patient seeking treatment as to the clinician providing it. "We need to eradicate that barrier" between patients and their own health data, said Gomez. He argued, however, that there is still a crucial place for health care providers in managing the onslaught of information, but they should act more as data docents. "We need to guide the patient," he said, but they will no longer accept being barred from the decision-making process.

The billion-dollar question, however, is how much will all of this cost? Despite the $19 billion set aside in ARRA, digitizing the nation's health record systems will likely cost a heck of a lot more, said Edward Rogoff, of Baruch College in New York City. Somewhere in the order of about $200 billion over five to 10 years, he estimated. But it should pay off, right? "It does make sense in a conceptual sense," he said. But, "what's the evidence? None." Certainly, technology and digitization has cut costs in industry after industry, yet a systems overhaul won't automatically translate into optimal efficiency and cost saving, he cautioned. Unless there are many players in the field, it could become "more or less the equivalent of cable television," he said, where large players dominate the market and prices remain high.

With mounting challenges and costs, Rogoff, whose presentation was given against a slide with a rainbow background, strived to capture the persisting concern, asking: "Is there a pot of gold at the end of this rainbow?" Raising again the question of just what it might take to get institutions and individual practitioners to make the long and expensive journey to find out.

Image courtesy of iStockphoto/ttueni

The views expressed are those of the author and are not necessarily those of Scientific American.

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