Monday, January 26, 2009

$20 billion boost to online medical records systems sorely needed

Glad to see President Obama has earmarked $20 billion for bringing more medical records online. Believe me, it is terrifying to take someone suffering cardiac symptoms to the ER of the hospital that performed their open heart surgery and you are told the ER physicians can't find their records.

I guess some nay sayers are claiming it will take a long time to bring technology people up to speed to handle the new infrastructure. I agree with Greg Beese, head of the technology support firm Logic Group, who says he estimates that it would take only about two months for technology support professionals to become familiar with the medical-specific aspects of health care records. Database professionals understand the basic structure of related record storage and health care records are not that much different than storing legal records or anything else for that matter. Medical records require more multimedia container fields to store images and graphic data like ECGs but the real trick is not in the basic structure, it is in the proper tagging and cross tagging of data so interrelated causalities can be identified. That information will need to be provided by medical specialists - not technology specialists. Besides if existing systems can be leveraged as templates for systems not yet created, the conversion could be expedited.

Of course there are also the ultra paranoid in the crowd that are wide-eyed in terror over privacy issues. As long as sufficent encryption systems are placed to protect data from hackers, I don't see any reason to be any more alarmed about online medical records than online banking records. The biggest danger in shared medical records, whether paper or online, is the financial gain that could be made by insurance companies or medical groups "leaking" information to those willing to pay for it to reduce risk exposure. The current flap over Steven Jobs health and the impact it has on Apple's shares is a prime example of how certain health records could be coveted by those interested in reaping profits from the stock market. Still, a leak can occur whether the information is in hard copy or online. Placing information online may actually make such a leak easier to track. Record access logs are far more tangible than relying on a clerk's memory or trying to force a hostile witness to admit they have broken confidentiality agreements.

"The computerized records, when used properly, are an indispensable tool for measuring, tracking and improving patient care — yet only about 17 percent of the nation’s doctors are using them. They are commonplace at large medical groups, but 75 percent of doctors practice in small offices of 10 physicians or fewer.

Doctors often benefit from inefficiency, because the dominant fee-for-service payment system means they are paid for doing more — more doctor visits, tests, surgical procedures, pills.

“Paying to put computer hardware and software in physicians’ offices isn’t going to do anything unless you change the incentives in the system,” said Dr. David J. Brailer, former national health information technology coordinator in the Bush administration.

There are some experiments with a pay-for-performance approach, in which Medicare gives medical groups bonus payments for meeting certain benchmarks of quality care. Monitoring that performance requires electronic health records. Yet to date, these have been isolated tests.

“You want to pay for achievement — better health quality and efficiency,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Harvard Medical School, who advised the Obama campaign. “But in the transition period, before financial incentives are reformed, you need to provide incentives or grants to use electronic health records because this technology is sort of the opening wedge to reform.”

Those eligible for grants to buy technology, a member of the Obama transition team said, will include inner-city and rural hospitals and small doctor practices. But most money, he said, will go to incentive payments to improve quality and safety of care."

But, I feel the rewards that could be realized in the advancement of treatment and quality of care will far outweigh these "chicken little (the sky is falling)" concerns.
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