Electronic Health Records for All

Electronic health record, or EHR, is an all-encompassing term that refers to all types of medical records, but also connotes the electronic sharing of medical information among patients, health care providers and payers (i.e., insurance or government agencies).

• EMRs (electronic medical records) fall under the EHR umbrella.  These legal records are used by physicians to document all patient information, such as test results, treatments, medications.
• PHRs (personal health records) also are EHRs. These are electronic records created by and accessible to the patients themselves. Data storage systems like Google Health and Microsoft’s HealthVault allow patients to create PHRs and make them available to doctors and others they approve. But the PHR systems don’t “talk” to each other or other comparable data storage programs such as RevolutionHealth or WebMD.

Both Microsoft and Google have recently formed partnerships with large health care providers like Kaiser Permanente and Mayo Clinic to determine if those providers could begin automatically transmitting patient data into PHRs for the patients they serve.

• EHRs may save money in administrative costs, which currently account for 31 percent of health care costs.
• EHRs may reduce medical errors and unnecessary tests.
• EHRs are more durable and portable than paper records. Joaquin Wong, co-director of the MDA Clinic at Children’s Hospital in New Orleans, knew a doctor who lost all his patients’ records under 10 feet of water after Hurricane Katrina. Many children had to receive a second set of immunizations in order to enter school.
• People think EHRs will help improve medical care. A poll conducted by the Harvard School of Public Health, the Kaiser Family Foundation and National Public Radio, with results released in April, found that 72 percent of survey respondents felt their own doctors could coordinate their work better if records were computerized; 53 percent said the number of medical errors would be reduced; 58 percent said fewer patients would receive unnecessary medical care; and 67 percent indicated the overall level of care would be improved nationwide.

• An EHR system costs a lot to implement. “[P]hysicians will pay much more than the incentives facilitate, and it will take up to 10 years for most of us to recover these additional costs, if ever.” — Douglas W. Jackson, physician and medical editor of Orthopedics Today, in a May 2009 article.
• Even after spending a lot of money, EHRs still may not work as well as hoped, critics say.
• EHRs can be hacked.  Millions of patients already have had their medical records stolen from computer systems. Recent victims include Virginia’s state prescription drug database and 160,000 students at the University of California, Berkeley.
• Unwanted people may have access to EHRs. Congressman Ron Paul (R-Texas), a longtime physician, introduced the Protect Patients and Physicians’ Privacy Act out of fear that government officials and state-favored interests will be able to view private medical records without patient consent.

• In April, Business Week recognized SSM St. Joseph West in Lake St. Louis, Mo., as among the most “completely wired” hospitals in the country for its use of paperless records.
• Eastern Maine Medical Center spent $35 million over 15 years to develop a working EHR system.
• St. Joseph’s Hospital, Bangor Maine, is completing an EHR system this year. The two-year project cost about $3 million. The hospital is keeping paper records as a backup.
• University of Pittsburgh Medical Center is expanding its 1991 system to extend its capabilities and interconnectivity to 20 other hospitals and 400 physician offices.
• Health Information Exchanges (HIE) — in which a group of hospitals/clinics or state and federal public health organizations exchange health care information — have potential, say supporters, pointing to the 500-member Community Health Information Collaborative in northeastern Minnesota.

• Cedars Sinai Medical Center, Los Angeles, spent $34 million on a computerized records system, but ceased using it after three months because several hundred physicians complained it overwhelmed them with too many alerts, reminders and questions.
• Kaiser Permanente decided to write off 40 years of effort and a $400 million investment in an early attempt at implementing EHR technology in conjunction with IBM. It has now purchased a functioning EMR system at a cost of $4 billion.
• Britain’s effort to implement a national EHR system has thus far cost $18.6 billion, and is four years behind schedule because of software and vendor problems.

Beginning in January 2011, hospitals will be eligible for a base amount of $2 million for installing EHR systems, with the possibility of getting up to $11 million.

Individual doctors’ offices that serve Medicare and Medicaid patients can receive $44,000 and more in incentives for installing systems that make “meaningful use” of EHRs (this term has not yet been defined).

Offices installing EHR systems in 2011 and 2012 will receive more money than those who wait until 2013 and beyond.

Beginning in 2015, care providers without EHR systems will incur financial penalties in the form of reduced Medicare incentives.

Because incentive payments will be spread over five years, physicians and hospitals most likely will have to pay for their systems out of their own pockets.