NY TIMES

Doctors Raise Doubts on Digital Health Data

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By STEVE LOHR
Published: March 25, 2009
Now that the federal government plans to spend $19 billion to spur the use of computerized patient records, the challenge of adopting the technology widely and wisely is becoming increasingly apparent.

Two articles, to be published on Thursday in the New England Journal of Medicine, point to the formidable obstacles to achieving the policy goal of not only installing electronic health records, but also using them to improve care and curb costs.

One article reports that only 9 percent of the nation’s hospitals have electronic health records, based on a survey of nearly 3,000 hospitals. The study, financed by the federal government and the Robert Wood Johnson Foundation, is the most definitive measure to date of the use of computerized patient records by hospitals. The government-backed study found a far lower level of use than some earlier, less rigorous surveys.

The study, the authors said, measured only the adoption of digital patient records. The survey did not ask whether the electronic records were used to advance the health policy goals of the federal plan, like tracking the quality of care and communicating effectively with outside specialists and clinics to coordinate a patient’s care.

“We have a long way to go,” said Dr. Ashish K. Jha, an assistant professor at the Harvard School of Public Health who was the article’s lead author. “And we did not measure effective use. Even if a hospital does have electronic health records, it does not mean it is sharing information with other hospitals and doctors down the road.”

In a second article in the journal, two experts in health information technology at Children’s Hospital Boston assert that spending billions of dollars of federal funds to stimulate the adoption of existing forms of health record software would be a costly policy mistake.

In the article, identified as a “perspective,” Dr. Kenneth D. Mandl and Dr. Isaac S. Kohane portray the current health record suppliers as offering pre-Internet era software — costly and wedded to proprietary technology standards that make it difficult for customers to switch vendors and for outside programmers to make upgrades and improvements.

Instead of stimulating use of such software, they say, the government should be a rule-setting referee to encourage the development of an open software platform on which innovators could write electronic health record applications. As analogies, they point to other such software platforms — whether the Web or Apple’s iPhone software, which the company has opened to outside developers.

In the Mandl-Kohane model, a software developer with a new idea for health record features like drug allergy alerts or care guidelines could write an application, and those could be added or substituted for a similar feature.

Such an approach, they say, would open the door to competition, flexibility and lower costs — and thus, better health care in the long run. “If the government’s money goes to cement the current technology in place,” Dr. Mandl said in an interview, “we will have a very hard time innovating in health care reform.”

To justify spending taxpayers’ money, the government program must expand digital records beyond routine tasks like billing to focus on “how the technology will be used to improve clinical performance,” said Herbert S. Lin, a senior scientist the National Academy of Sciences, an advisory group to the government.

The Obama administration’s health technology plan, which is part of the economic recovery package, includes incentive payments for adopting electronic health records — more than $40,000 per physician and up to several million dollars for hospitals. The payments are spread over a few years and are based on “meaningful use” of “certified” records, although Congress left defining those terms to the Department of Health and Human Services.

The incentive payments, industry experts say, are enough to greatly accelerate the adoption of electronic health records. In the new survey of hospitals, the cost of digital record systems was cited as the single largest obstacle to adoption.

Dr. David Blumenthal, a professor at the Harvard Medical School, oversaw the hospital study. Last week he was named the national coordinator for health information technology in the Obama administration. In a conference call to discuss the study, Dr. Blumenthal declined to talk about his plans in detail.

But clearly, he sees electronic health records as a tool to reform health care, and the Obama administration intends to shift Medicare and Medicaid reimbursement toward paying for better health outcomes, which will be measured and monitored using technology.

“The goals are quality and efficiency, instead of just putting machinery in offices,” Dr. Blumenthal said. “If we encourage better performance, then physicians are going to find ways to improve performance. And health information technology is one crucial way to do that.”