[Med-privacy] EMRs

[pmarshall]

Government pushes for electronic medical record standards

Legislation  would  help  fund  system purchases  and ensure  that users

could share data.

By Markian Hawryluk, AMNews staff. Feb. 9, 2004.

Washington -- Momentum  is building for  federal legislation  to promote

universal   adoption  of  electronic   medical  records   by  developing

standards  for  the  software  and  incentives  for  its  use.  But many

physicians  remain  concerned  that  they might  get steamrolled  in the

process.

Many experts are advocating electronic records as a  way to  cut medical

errors, provide doctors with up-to-date patient histories, and  put best

practices  and  clinical guidelines at  their fingertips.  Entering data

into  electronic  records  could  facilitate  quality   measurement  and

improvement, cut paperwork, and streamline health transactions.

Proponents  envision a  system under which  a patient's  medical records

could  easily be  shared electronically among  doctors and  other health

care professionals caring for the patient.

Yet recent surveys have found that only 17%  of primary  care physicians

and fewer than 5% of  all physicians have  electronic record  systems. A

study soon to be released by the Commonwealth  Fund found  that adoption

of  and  receptivity  to  health   information  technology   among  solo

practices  and  small  groups  lags  significantly  behind  large  group

practices.

Physician groups have supported the concept of moving  toward electronic

records with data exchange  capabilities but want  to avoid  an unfunded

mandate.

"Although  physicians see  great promise in  this technology,  the costs

are prohibitively high, and  they're not confident  that, if  they spend

the  money,  they  won't  be  buying the  Betamax version  of electronic

technology,"  said  Bob  Doherty,  senior  vice president  of government

affairs for the American College of Physicians.

The college has called for  the Bush administration  to create  a policy

framework to reduce the barriers to voluntary acquisition  of electronic

records  systems,  including  helping  practices  pay for  the software,

sharing   accrued   savings   and    developing   the    standards   for

interoperability.

"A  lot  of  the  initiatives  right  now  are  dealing  with this  on a

30,000-foot level," Doherty said.  "What we're doing  is trying  to take

the discussion to the level of  what are the  reasons a  physician would

acquire this technology and why would a physician not acquire it?"

The  American  Academy  of Family  Physicians, meanwhile,  has partnered

with  a  handful  of  software  vendors   to  offer   family  physicians

implementing such record systems discounted  products and  services. The

group  also  will  work  on  developing  interoperability  and  security

standards for exchanging data between physicians  and other  health care

professionals.

But it may take  a greater  federal role to  help move  standards along.

The  Bush  administration  last  year  commissioned  the   Institute  of

Medicine to design a standardized model of an electronic  medical record

and asked the  health care standards  development organization  known as

HL7 to evaluate it. The Dept.  of Health and  Human Services  expects to

have a model record ready this year.

"We want to build a standardized platform on which  physicians' offices,

insurance   companies,   hospitals  and   others  can   all  communicate

electronically,  which  will  improve  patient  care while  reducing the

medical  errors  and the  high costs plaguing  our health  care system,"

said HHS Secretary Tommy Thompson.

The  American  Medical  Association  is  part of a  group that  has been

reviewing a draft of the model. Once the model is completed, it  will be

tested in demonstration projects and studies. But it is unclear  how the

standards will be implemented and whether electronic medical  record use

would  be  mandated.  Significant  issues  about  security  and  patient

privacy also must be resolved.

Last  November,  the  IOM  said  electronic records  could significantly

reduce medical errors but identified a number of barriers.

"The lack of data standards is a  key obstacle to  the adoption  of both

electronic health records  and data exchange  systems," said  Molly Joel

Coye, CEO of Health Technology Centers in San Francisco and a  member of

the  IOM  committee  that  penned  the  report.  "Physicians  and  other

providers have hesitated to invest in data systems  -- reasonably  so --

knowing  that  their  own  medical  record system might  not be  able to

exchange important patient information with local  pharmacies, hospitals

or even other physicians."

The IOM said the private sector could be expected to fund  a substantial

portion  of  the  capital  required  to  build  a  national   system  of

computerized   health   information  and   data  sharing,   but  federal

investment  would  be  needed  to  develop  key  building blocks  of the

infrastructure.

Now a number of policy-makers have picked up the banner.  President Bush

called for electronic records in  his State of  the Union  address. This

fueled  speculation  that  his 2005 budget  proposal would  include more

steps or incentives to promote their use.

And in January, two key Democratic  senators announced  legislation that

could help  speed adoption.  Sen. Hillary Clinton  (D, N.Y.)  outlined a

bill  that  would  mandate the development  of standards  for electronic

records and provide funding for physician offices to buy the systems.

"The government should also help ensure that IT is affordable  for small

or rural providers, and for safety net  providers," Clinton  said. "I've

supported funding this, perhaps, through a revolving  loan fund,  and we

should  be  encouraging innovation  in business models  for how  to make

this affordable."

Sen. Edward Kennedy (D,  Mass.) also announced  that he  would introduce

legislation including an electronic records provision.

"Automated patient  record-keeping can help  bring real  coordination to

what is often  a frighteningly fragmented  health care  system," Kennedy

said.  "Today,  for  one  in  five  patients  with   significant  health

problems,  various  health  professionals  order  duplicate   tests  and

procedures. One  in four  arrives for a  doctor's appointment  and finds

that needed test results or records are not available."

Both Kennedy and Clinton  serve on the  Senate Health,  Education, Labor

and Pensions Committee, chaired by Sen. Judd Gregg (R, N.H.).  The panel

could  be  a  venue  for  debate  of the  measures. Gregg  has indicated

support  for developing  electronic record standards  but wants  to move

slowly due to the issue's complexity.

[AMNews]