Electronic Health Records: The Next Step in Health Care Management

Although electronic health records have been used for the past few years, it garnered attention during the 2008 U.S. presidential race with the discussion focused on the area of health care reform. The New York Times published an article, "City to Pay Doctors to Contribute to Database," on December 29, 2008 about how doctors in New York City is working with 1,000 primary-care physicians in using a $60 million city health department project aimed to create an electronic record-keeping system. (Photo courtesy of Brian Palmer for The New York Times.)

"Experts say it is the most ambitious government effort nationwide to harness electronic data for public-health goals like monitoring disease frequency, cancer screening and substance abuse....The system, custom-designed for New York by a Massachusetts company, eClinicalWorks, would cost a typical doctor’s office $45,000 to implement, but city subsidies reduce that to $24,000 for practices with at least 10 percent of their patients on Medicaid or uninsured; those in neighborhoods with the highest poverty rate pay $10,000. The health department is also putting together groups of doctors to share services like calling or sending text messages to patients to remind them of follow-up visits."

On December 1, 2008, Milliman, Inc., a Seattle-based global consulting and actuarial firm, sponsored the Healthcare Town Hall. This event consisted of ten panelists representing government agencies from all levels (federal, state, and local), nonprofit organizations, and the private sector. The evening's agenda focused on four areas:

1. What are electronic health records (EHRs) and what can they do?
2. How do we encourage EHR adoption?
3. Who owns the information that is gathered?
4. What can/should we do with this information?

You can watch the program in its entirety below courtesy of TVW, but here are a few points of interest from the event:

• Scott Armstrong, President and CEO of Seattle-based Group Health Cooperative, said that Group Health has been using electronic health records for four years with very effective results. Patients feel empowered having easy access to their medical records, which make them more educated when making a medical decision. Group Health has invested in secured accessibility to patient records. However, according to Mr. Armstrong, Group Health has been unable to quantify profitability since there are too many outside factors.
• Mike Kreidler, Washington State Insurance Commissioner, said that 40 percent of funds in the health care system is wasted. The panel collectively agreed that electronic health records will make the system more efficient and reduce costs and financial waste.
• Ron Sims, King County (WA) Executive, noted that many medical professionals cannot afford to implement an electronic health record system.
• John Hammarlund, regional administrator for the Seattle and Chicago offices of the Centers for Medicare and Medicaid Services explained that he has not seen any good business cases using electronic health record technology, "No studies in correlation between electronic health records and quality of health care."
• The discussion shifted to standardizing electronic health records where Mr. Hammarlund said that an industry standard should be created, but this responsibility should not rest solely on the federal government nor should it be left up to the private sector, but a collaborative effort between the two. Moreover, according to Mr. Hammarlund, we should be paying for greater value for health care rather than volume.
• Joe Scherger, MD, a consulting medical director for informatics at San Francisco-based Lumetra, a health care consulting organization, believes electronic health records will be incorporated in our daily lives similar to e-banking and online shopping.
• Regarding ownership of the information, Ron Sims said the consumer (patient) should solely control the release of medical records and warned of the consequences should genetic information be stored in electronic health records.
• Rich Moyer, the MedInsight® product manager in Milliman's Seattle office further questioned who legally owns the information. If a medical provider is using Microsoft HealthVault (there are dozens of health information management systems including Google Health), does the patient, medical provider or information management system own the data? George Scriban, Microsoft HealthVault's senior global strategist quickly responded that his company does not own the data, but they simply manage the database.
• Dr. Scherger made an excellent point by saying Internet access is a public health issue. It is one thing to have an EHR, but a digital divide still exists in many communities throughout the United States, particularly in minority communities. However, he explained that disadvantaged communities in Orange County, California have a very high child vaccination rate as a result of electronic health records and an expansive volunteer network.

Issues or concerns about electronic health records include:

1. Who owns the electronic health records? The patient, health care provider, insurance company, data storage company?
2. What information should be stored in electronic health records? Genetic/DNA information? If so, will this allow insurance companies the ability to prescreen applicants and deny coverage or benefits based on genetic code?
3. How do you guarantee the accuracy of information posted?
4. Who should create an industry standard for electronic health record systems? Governments, nonprofit groups, private sector or a collaborative effort among the three?
5. How do we encourage electronic health record adoption? As The New York Times article indicates, a electronic health record database may be cost prohibitive for medical providers without government subsidies.
6. Need to integrate preventive medical information and pertinent resources into electronic health records.

There is no question that electronic health records will quickly become the norm in managing healthcare. EHRs will allow the patient to become better educated when making medical decisions and I hope EHRs will give patients not only the ability to manage medical treatments, but EHRs will be used as a source for preventive medicine. One significant concern I have is without proper regulations and oversight, medical information that should remain confidential between the medical professional and patient could be misused particularly if DNA information is included in electronic health records.

Electronic health records will certainly provide a great benefit to people living in industrialized nations, but can you imagine the positive impact EHRs would have on billions of people living in the developing world?