Digital Health Records Still Elusive

WASHINGTON -- President George Bush's administration gets high marks for its vision in pushing electronic health records, but the U.S. is far from implementing a national health IT system, according to an author of a government report released late last week.

Although the U.S. could see significant benefits from more use of technology in the health-care industry, including fewer deaths from medical errors, more work needs to be done to create standards for electronic health records and other health IT initiatives, said David Powner, director of IT management issues for the Government Accountability Office.

Congress Hears Pitch

The government still faces an "enormous challenge" in getting electronic health records to patients, Powner told the House Committee on Government Reform.

Asked to grade the Bush-created office of the National Coordinator for Health Information Technology, Powner gave the office an "A" for leadership and vision but an incomplete grade for implementation. In January 2004, Bush called for the health care industry to embrace electronic health records, with the records available to all U.S. residents by 2014.

Powner's report to the committee called for the Bush administration and the Department of Health and Human Services to push for health IT standards that don't yet exist.

"Otherwise, the health care industry will continue to be plagued with incompatible systems that are incapable of exchanging key data that is critical to delivering care and responding to public health emergencies," Powner wrote.

The Bush administration is working toward setting standards, said Dr. David Brailer, the national coordinator for health IT in the Department of Health and Human Services. This week, Brailer's office will announce a federal government partner to harmonize health IT standards, he said.

In addition to standards, the cost of implementing electronic health records, and a lack of technical expertise, is holding up adoption at many small health-care facilities, Brailer told the committee. While existing research has sent "mixed signals" on the ability of electronic health records to cut costs, health IT can "save lives, improve care and improve efficiency in our health system," he said.

Federal Endorsement?

Part of his office's job is to convince health-care providers and patients of health IT's benefits, Brailer added. Some health-care providers have been slow to adopt electronic health records because they're paid per patient visit, and they aren't paying the bills, he said.

"It is against the financial interest of many providers to improve quality or to improve efficiency, because we pay by volume, and greater efficiency and quality, by definition, reduce volume," he said.

Committee member Jon Porter, a Nevada Republican, said he plans to introduce legislation in the next couple of weeks that will require electronic health records for people using government health insurance coverage. With about 9.5 million members on the federal health plan, the requirement would push adoption to the private sector as well, Porter said.

Porter repeated concerns that the lack of electronic health records is adding to medical errors. "We are so far behind in our technology, we are costing lives of many Americans," he said.

Useful for VA

In 1999, the Institute of Medicine, a nonprofit health analysis organization, issued a study saying between 44,000 and 98,000 U.S. residents die each year due to medical errors.

Powner and other witnesses also talked about the potential for the health-care system to save money by deploying technology. As health care costs rose dramatically nation-wide, the Department of Veterans Affairs doubled the number of patients served in the past ten years, while increasing its health care budget by only 50 percent, said Dr. Robert Kolodner, chief health informatics officer at the Veterans Health Administration, which is part of the VA. The VA's health-care budget in 2004 was $29.1 billion, with more than 5 million people receiving health-care services through the VA.

Kolodner attributed the VA's ability to hold down costs directly to its use of electronic health records. "I have used VA's electronic health record system for years," he said. "As a doctor--and as a patient--I am very enthusiastic about the benefits of this technology."

Recent Hurricanes Katrina and Rita showed the need for electronic health records that follow patients, Kolodner added. The VA began rolling out an electronic health records system in the mid-1990s, and today, all 1300 VA medical facilities use electronic records, Kolodner said.

Katrina had a "significant impact" on the operation of a dozen VA facilities, destroying one and forcing another to be evacuated, and the two recent hurricanes scattered Gulf Coast evacuees across the country, he said. But the VA was able to get access to basic medical data such medication information for patients treated at those facilities a day after Katrina hit, with full medical records available in about a week, Kolodner added.