[Med-privacy] "Road Map to a Digital System of Health Records"
Peter Marshall
pwm@comcast.net
Wed, 19 Jan 2005 10:47:37 -0800
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January 19, 2005
Road Map to a Digital System of Health Records
By STEVE LOHR
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<bold><fontfamily><param>Helvetica</param><x-tad-bigger>January 19,
2005
</x-tad-bigger><bigger><bigger><bigger><bigger><bigger><bigger><x-tad-bigger>Road
Map to a Digital System of Health Records
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By STEVE LOHR
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ew dispute the need to move America's costly, fragmented health system=20=
from paper records and prescriptions into the computer age.
Converting to digital records, health authorities agree, would reduce=20=
medical errors and improve efficiency, saving both lives and dollars.
But what has been missing is a national road map that would encourage=20
doctors, hospitals and insurers to invest in modern information=20
technology.
Yesterday, a group of 13 health and information technology=20
organizations gave the Bush administration its recommendations for just=20=
such a road map for a national health information network.
The group's report suggesting the principles that should guide the=20
creation of such a network made an emphatic call for open,=20
nonproprietary technical standards for communication across the=20
network.
The information on a patient inside a doctor's office, the report=20
contends, must be capable of being sent across the network freely to=20
hospitals, laboratories, specialists, insurers and researchers, if the=20=
promise of improved care and reduced costs are to be achieved.
"The issue we tried to address is how do we mobilize America's=20
incredibly fragmented health system to really get this done," said=20
David Lansky, a director of the health program at the Markle=20
Foundation, which coordinated the work of the organizations involved,=20
including the American Health Information Management Association, the=20
Healthcare Information and Management Systems Society and the Liberty=20
Alliance Project.
The study was delivered to the Bush administration's national health=20=
information technology coordinator, Dr. David J. Brailer, who had asked=20=
for recommendations on how to build a national health information=20
network.
The 54-page document, which the group calls a "common framework,"=20
borrows heavily from the technical and policy approach of the Internet.=20=
The federal government, the report says, should guide the development=20
of a health network with a light hand by providing some initial=20
financing and endorsing basic technical standards, but should set up a=20=
separate "standards and policy entity" to handle the task.
The report also noted that while the task might seem to warrant "a=20
'moon-shot'-type approach," the "political and practical realities=20
suggest that an incremental approach would gain more support."
The report concluded that a national health network should not include=20=
a central database of patient records nor should it require individuals=20=
to have "health ID cards," as some have proposed. It said that patients=20=
should control their own records, deciding whether their information=20
can be used in studies for effectiveness of certain treatments and=20
drugs.
One goal is to have the health network operate somewhat like=20
Internet-based e-mail, in which people using different types of=20
computers and software can send and receive messages because the open,=20=
standard technology for handling messages is used by everyone.
Separately, an article expected to be published today in the online=20
version of the journal Health Affairs estimates that $78 billion a year=20=
could be saved by moving to electronic patient records in a network=20
with open communications standards, or interoperability, in computing=20
terms.
That is the estimated yearly savings after 10 years, when a truly=20
open, automated system is in place across the nation, according to the=20=
report by the team of researchers in the Center for Information=20
Technology Leadership. The center is the research arm of Partners=20
Healthcare, a nonprofit medical group that includes Massachusetts=20
General Hospital and Brigham and Women's Hospital in Boston.
The cost to doctors and hospitals of installing computers, networking=20
equipment and software to build an electronic health network will be=20
daunting - an estimated $276 billion over the next 10 years, the=20
researchers estimate. The annual savings from digital patient records=20
would be considerably lower - about $24 billion a year - if the=20
communications standards were not fully open, the study found.
Under a less open system, doctors, hospitals, insurers and patients=20
could still share information, but doing so would require costly=20
software changes to permit information-sharing outside a proprietary=20
network. With employers changing insurers frequently and individuals=20
often referred to several doctors, those costs could be daunting.
Many medical groups are starting to make sizable investments in=20
creating local networks that connect electronic patient records. But=20
without moving swiftly to establish open communications standards=20
between those networks, the study's authors said, a large opportunity=20
for savings may be lost.
"If we're not careful, we'll have little islands of excellence that=20
don't talk to each other," Jan Walker, the lead author of the article=20
in Health Affairs, said in an interview.
President Bush has spoken frequently about the need to move to=20
electronic health records and last May appointed Dr. Brailer to the new=20=
post of health information technology coordinator. But last November,=20
Congress eliminated a seemingly modest $50 million request for Dr.=20
Brailer's office for technology demonstration projects.
"More aggressive leadership at the national level is needed, and time=20=
is of the essence," Dr. Blackford Middleton, chairman of the Center for=20=
Technology Leadership and an assistant professor at Harvard Medical=20
School.
In a commentary accompanying the Health Affairs article, Laurence=20
Baker, an associate professor at Stanford Medical School, questioned=20
the authors' assumptions about savings from reduced labor costs and=20
redundant tests eliminated. He called the study's conclusions "a very=20
optimistic assessment."
The study did not try to measure improvements in health care because of=20=
better access to patient information.
Dr. Brailer, who also wrote a commentary for Health Affairs, said the=20=
improvement in reduced medical errors and better care would be=20
significant, along with cost savings. He also endorsed the call for=20
open standards.
Copyright 2005=A0The New York Times Company=20=
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<fontfamily><param>Skia</param><bigger><bigger>ew dispute the need to
move America's costly, fragmented health system from paper records and
prescriptions into the computer age.
Converting to digital records, health authorities agree, would reduce
medical errors and improve efficiency, saving both lives and dollars.
But what has been missing is a national road map that would encourage
doctors, hospitals and insurers to invest in modern information
technology.
Yesterday, a group of 13 health and information technology
organizations gave the Bush administration its recommendations for
just such a road map for a national health information network.
The group's report suggesting the principles that should guide the
creation of such a network made an emphatic call for open,
nonproprietary technical standards for communication across the
network.
The information on a patient inside a doctor's office, the report
contends, must be capable of being sent across the network freely to
hospitals, laboratories, specialists, insurers and researchers, if the
promise of improved care and reduced costs are to be achieved.
"The issue we tried to address is how do we mobilize America's
incredibly fragmented health system to really get this done," said
David Lansky, a director of the health program at the Markle
Foundation, which coordinated the work of the organizations involved,
including the American Health Information Management Association, the
Healthcare Information and Management Systems Society and the Liberty
Alliance Project.
The study was delivered to the Bush administration's national health
information technology coordinator, Dr. David J. Brailer, who had
asked for recommendations on how to build a national health
information network.
The 54-page document, which the group calls a "common framework,"
borrows heavily from the technical and policy approach of the
Internet. The federal government, the report says, should guide the
development of a health network with a light hand by providing some
initial financing and endorsing basic technical standards, but should
set up a separate "standards and policy entity" to handle the task.
The report also noted that while the task might seem to warrant "a
'moon-shot'-type approach," the "political and practical realities
suggest that an incremental approach would gain more support."
The report concluded that a national health network should not include
a central database of patient records nor should it require
individuals to have "health ID cards," as some have proposed. It said
that patients should control their own records, deciding whether their
information can be used in studies for effectiveness of certain
treatments and drugs.
One goal is to have the health network operate somewhat like
Internet-based e-mail, in which people using different types of
computers and software can send and receive messages because the open,
standard technology for handling messages is used by everyone.
Separately, an article expected to be published today in the online
version of the journal Health Affairs estimates that $78 billion a
year could be saved by moving to electronic patient records in a
network with open communications standards, or interoperability, in
computing terms.
That is the estimated yearly savings after 10 years, when a truly
open, automated system is in place across the nation, according to the
report by the team of researchers in the Center for Information
Technology Leadership. The center is the research arm of Partners
Healthcare, a nonprofit medical group that includes Massachusetts
General Hospital and Brigham and Women's Hospital in Boston.
The cost to doctors and hospitals of installing computers, networking
equipment and software to build an electronic health network will be
daunting - an estimated $276 billion over the next 10 years, the
researchers estimate. The annual savings from digital patient records
would be considerably lower - about $24 billion a year - if the
communications standards were not fully open, the study found.
Under a less open system, doctors, hospitals, insurers and patients
could still share information, but doing so would require costly
software changes to permit information-sharing outside a proprietary
network. With employers changing insurers frequently and individuals
often referred to several doctors, those costs could be daunting.
Many medical groups are starting to make sizable investments in
creating local networks that connect electronic patient records. But
without moving swiftly to establish open communications standards
between those networks, the study's authors said, a large opportunity
for savings may be lost.
"If we're not careful, we'll have little islands of excellence that
don't talk to each other," Jan Walker, the lead author of the article
in Health Affairs, said in an interview.
President Bush has spoken frequently about the need to move to
electronic health records and last May appointed Dr. Brailer to the
new post of health information technology coordinator. But last
November, Congress eliminated a seemingly modest $50 million request
for Dr. Brailer's office for technology demonstration projects.
"More aggressive leadership at the national level is needed, and time
is of the essence," Dr. Blackford Middleton, chairman of the Center
for Technology Leadership and an assistant professor at Harvard
Medical School.
In a commentary accompanying the Health Affairs article, Laurence
Baker, an associate professor at Stanford Medical School, questioned
the authors' assumptions about savings from reduced labor costs and
redundant tests eliminated. He called the study's conclusions "a very
optimistic assessment."
The study did not try to measure improvements in health care because
of better access to patient information.
Dr. Brailer, who also wrote a commentary for Health Affairs, said the
improvement in reduced medical errors and better care would be
significant, along with cost savings. He also endorsed the call for
open standards.
=
</bigger></bigger></fontfamily><fontfamily><param>Helvetica</param><color>=
<param>0000,0000,6666</param><smaller><smaller>Copyright
=
2005</smaller></smaller></color></fontfamily><fontfamily><param>Skia</para=
m><bigger><bigger>=A0</bigger></bigger></fontfamily><fontfamily><param>Hel=
vetica</param><color><param>0000,0000,6666</param><smaller><smaller>The
New York Times
=
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aram><bigger><bigger> </bigger></bigger></fontfamily>=
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