Lack of standards hinders electronic health records

The health care industry needs to use IT better, but many doctors and hospitals are concerned about implementing technology such as electronic health records without interoperability standards in place, members of a new U.S. government task force focusing on health IT said Monday.

Early pioneers of electronic health records face significant risks, even though U.S. President George Bush is pushing for electronic health records to be available to all U.S. residents by 2014, said speakers at the first meeting of the Commission on Systemic Interoperability. The commission, established in the December 2003 Medicare Modernization Act, is charged by Congress with creating a strategic plan for the nation's health IT infrastructure.

While some large hospitals and medical practices have moved to electronic health records, many other hospitals and doctors fear that electronic health record software they buy now might not work with standards eventually adopted by the health care industry or the government, said Dr. Mark Leavitt, medical director of the Healthcare Information Management Systems Society. Without widespread adoption, the cost of electronic health record technology remains high, and smaller hospitals and practices are hesitant to use the technology until the cost goes down and the industry has interoperability standards, he added.

"Those who adopt electronic health records now do so at a disadvantage," said Dr. David Brailer, appointed by Bush in May to be the national health care information technology coordinator. "It's unclear whether (early adopters) are financing everyone else, or whether it's better to wait."

In addition, health care providers are concerned that they won't see much direct cost-savings benefits from the costly conversion to electronic health records -- laboratories, pharmacies and consumers are more likely to benefit after doctors and hospitals switch to electronic health records, Leavitt said.

"You could spent time and money and end up with nothing," Leavitt said. "What we have now is a deadlock."

Under the current health care insurance system, providers have little incentive to adopt new technologies, said Dr. Barry Blumenfeld, associate director of clinical informatics research and development at Partners Healthcare System Inc., based in Massachusetts. "Providers aren't reimbursed or financially rewarded for sharing information," he said.

More than 90 percent of medical practices with fewer than 50 doctors do not make significant use of IT, Leavitt said. But in many large hospitals and practices, electronic health records are used by 50 percent of doctors, Brailer said.

"I think the challenge is not adoption, the challenge is the adoption gap," Brailer said.

Advocates of electronic health records say health records, which can follow patients wherever they go, are the foundation for widespread adoption of IT in the health care industry. The records are convenient for patients, can significantly reduce medical errors and can help public health experts track health problems in populations, advocates say.

The health care industry needs to adopt technology to cut skyrocketing costs and to improve efficiency, said Scott Wallace, president and chief executive officer of the National Alliance for Health Information Technology and chairman of the new commission.

"It's a cause that has the best potential for transforming health care in America for the better," added Tommy Thompson, U.S. secretary of health and human services, speaking to the commission.

Despite the current concerns, electronic health records are essential to the future of the health care industry, said Gary Mecklenburg, president and chief executive officer of Northwestern Memorial HealthCare, based in Chicago.

"Those of us in health care have to get over thinking this is a choice," Mecklenburg said. "We must have technology. It's the cost of doing business -- that's what we have to get over."

The commission has until October to come up with a plan for interoperability among health IT systems.

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