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Making Medicine Modern

Switching from paper to electronic record keeping can save lives. And now the U.S. government is pushing to accelerate the transition.

The Bush administration outlined a 10-year plan last week to create a national health information infrastructurethe first coordinated effort by the federal government to promote the use of potentially lifesaving electronic health records.

The plan was released by Tommy Thompson, Secretary of Health and Human Services, at a Secretarial Summit on Health Information Technology that was attended by many of the nations leaders in electronic health records. The proposed strategy includes efforts to create standards to make health information systems interoperable across the country, as well as grants to nine communities to develop citywide health information exchanges and plans to fund additional, similar demonstration projects.

Advocacy groups have been calling for greater use of electronic health records for decades. Indeed, in 1991 the Institute of Medicine issued a report calling computerized patient records an essential technology for health care; the same year, the U.S. General Accounting Office stated that such technology could improve patient care, increase efficiency, and reduce costs. Since then, however, progress toward adoption of electronic record keeping has been slow, with important advances happening only in small pockets.

The latest proposals, experts say, are importantbut dont go far enough. The new initiatives to accelerate adoption of health information technologies are a necessary and welcome, but insufficient step toward widespread use, says Suzanne Delbanco, CEO of The Leapfrog Group, a coalition of major corporate-insurance purchasers such as AT&T, General Motors, and IBM using their purchasing power to initiate improvements in the safety of health care. The momentum they are creating, however, has created a mindset where we know what the future looks like, and it is just a question of determining how we are going to get there.

One scheme echoes a major goal of the Leapfrog Group: in an effort to reduce medication errors, Medicare has launched an electronic drug prescribing initiative. In a 1999 study, the Institute of Medicine reported that almost 7,400 Americans may die annually from medication errors; such mistakes remain a huge problem. Systems in which doctors enter prescriptions directly into a computer have proven to be lifesavers in the hospitals that use them, helping to ensure that patients receive the right medication at the right dosage, as well as alerting doctors to potentially dangerous drug interactions.

The Medicare Modernization Act of 2004 requires drug plans participating in the new Medicare drug benefit use e-prescribing based on national standards by 2009, but the technology will start to appear well ahead of that. Since Medicare is the single biggest insurer in the United States, this requirement is likely to accelerate the nationwide adoption of computerized prescribing.

Medicare also announced a pilot program to make so-called transaction information accessible online to Indianas 900,000 Medicare recipients. Beginning later this year, a website will present information currently available via 1-800-MEDICARE, such as the dates and purposes of doctor and hospital visits and which tests a patient had received. (Actual test results would not be available). The goal is to learn how many people would use the system and what types of information they would like to access. If it proves popular, the site will eventually include reminders about preventive benefits subscribers havent taken advantage of, such as mammograms and flu shots.

The Department of Health and Human Services may eventually use Medicare as a sort of carrot and stick to help convince medical practices to make the costly switch from paper to electronic record keeping, according to last weeks report. For instance, doctors who use electronic records may receive higher reimbursement for Medicare patients. Also under consideration: regional grants to facilitate hospital adoption of electronic records and community interchanges, and low-interest loans to help physicians and hospitals purchase the systems.

Whether the buzz of last weeks meetingwhich had about 2,300 attendees from public and private health-care systemswill translate into widespread adoption of electronic medical records within the 10-year framework remains a big question for a field that has been swimming against the information technology tide for more than 20 years. But some experts are optimistic. Theres some very good potential in all this, says Clement McDonald, a pioneer in electronic medical records and the director of the Regenstrief Institute in Indianapolis. I think there are still difficult problems that it will take time to work through. [But] its on the positive side to have this much federal and industry interest. As for the projected timeframe, he says that 10 years is just about right.

Carol Diamond, managing director of the Markle Foundations Information Technologies for Better Health group, hopes for even better. Really getting this agenda to move is going to be very dependent on an ongoing collaboration by the public and private sectors, she says. But if we continue to pay serious attention to this issue, and if we address all of the different challenges we have in getting this issue acted upon, Im hoping we can get there even sooner.

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