Digital Health Records

Posted May 12, 2009, at 7:19 p.m.

Advocates say that computerizing medical records will improve health care and save lives and money, and the new federal budget includes $19.2 billion for information technology. But there’s a lot more to the story.

First of all, it’s costly. The New England Journal of Medicine reported a survey last month showing that only 1.5 percent of U.S. hospitals had completed a comprehensive electronic-records system and cited cost as the main obstacle. Among the exceptions, Bangor’s St. Joseph Hospital, which plans to complete a two-year digitalization project this year, is spending $3 million on it. And Eastern Maine Medical Center has spent $35 million in 15 years developing a system that last year won The Healthcare Information and Management Systems Society’s annual award for excellence.

Second, digitalization doesn’t always work well. Cedars Sinai Medical Center in Los Angeles spent $34 million on a new computer system and abandoned it after several hundred physicians complained that it interfered with their medical judgments and overwhelmed them with too many reminders, questions and alerts.

The Journal of Usability Studies reported a failure rate of 30 percent, citing another abandonment at Kaiser Health Plan clinics in Hawaii. Clinicians found the system cumbersome and time-consuming. Kaiser is trying another system but is having trouble there, too. St. Joseph’s, probably to be on the safe side, is going to have a hybrid system, keeping its paper record-keeping as well as going digital.

A third difficulty stems from the number of competing systems being offered. In the Obama administration’s plan, they all must “talk to each other,” to create a big national database by 2014. The goal is to help judge quality of health care and find where is the best and most efficient service and where there are too many mistakes.

Government administrators may propose avoiding procedures and medications found to be unnecessary or too expensive — all in the interest of curbing health care cost. Critics call that health care rationing, but rationing already exists for the uninsured and those who can’t afford it.

As hospitals and other health providers begin to turn to electronic record keeping, The Wall Street Journal has reported that the U.S. Veterans Health Administration’s system offers a system that is both excellent and cheap. Unlike proprietary systems, the VA’s was created by taxpayer dollars and is in the public domain.

The April 30 article said that Midland Memorial Hospital in Texas chose the free VA system, bought the necessary hardware, and hired a company to adapt the VA software for commercial use, and had a full electronic medical-records system for less than $7 million. Wide adoption of the VA system would permit seamless interaction across the country. It sounds worth considering.

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