computer-based patient records reduce errors Bush adm says

[malernee]

New York Times
Government Wants to Bring Health Records Into Computer Age
By STEVE LOHR

Published: July 21, 2004


he Bush administration plans to announce today a long-term plan for modernizing the nation's health care system with information technology, bringing patient records and prescriptions out of the realm of ink and paper and into the computer age.

The administration's strategy, presented in a report to be published today, regards the government's role as one of mainly setting goals and working with the private sector to establish product and technology standards so the computer systems of doctors, hospitals, laboratories, pharmacists and insurers can efficiently communicate and share information.

The government, according to the report, will also use its formidable buying power as the largest purchaser of health care - through federal Medicare and Medicaid programs - to accelerate the transition to electronic patient records, reversing what the report terms "a previous lack of cohesive federal policies supporting" health information technology.

"There is an absolutely important role for government," Tommy G. Thompson, the secretary of health and human services, said yesterday.

Because the health care industry is so fragmented, Mr. Thompson said, the government must encourage standards to reduce the risk of technology investments.

"Then," he added, "we have to demand that the medical industry invest in technology."

The report, "The Decade of Health Information Technology," is being published today at the beginning of a government-sponsored conference in Washington. It says that the government should work closely with the private sector to ensure common product standards for storing electronic health records, so data can be shared among institutions and personal information can be kept secure. A product certification system, the report says, should be considered.

The government also plans to organize a consortium of private companies to plan, build and operate health information networks. A Health Information Technology Leadership Panel of industry executives and health care experts will be created to advise the government on the costs and benefits of health technology, and will report in the fall. Among other steps, the government will create a Web site where Medicare beneficiaries can review customized information about services they have received. A pilot test of the Web site will be conducted in Indiana this year.

The savings from making the transition to electronic health records, according to administration officials and health care experts, could be sizable in terms of both dollars and lives. The report estimates that if most patient records were in electronic form, the savings would be about $140 billion a year, or nearly 10 percent of the nation's annual health care bill.

Besides the cost savings from reduced paper handling, the automation of an electronic system could sharply reduce medical errors, which are estimated to be responsible for 45,000 to 98,000 deaths a year - more than breast cancer, AIDS or motor vehicle accidents, according to the Institute of Medicine of the National Academy of Sciences.

Some of those errors result from simple lapses - a patient who receives the wrong drug, for instance, when a nurse or pharmacist misreads an illegible handwritten prescription. Others result because laboratories' test results are not immediately sent to doctors to alert them if patients are reacting badly to drugs.

"Without computer-based patient records, those errors are not going to be reduced," said Dr. Thomas Handler, a research director at Gartner, the technology research firm.

The $1.5-trillion-a-year health care industry has not invested much in information technology, compared with most businesses. In the health care industry, the investment in information technology - computer hardware, software and services - is about $3,000 for each worker, compared with $7,000 a worker on average for private industry and nearly $15,000 a worker in banking.

Hospitals and clinics have invested heavily in medical technology like magnetic resonance imaging machines and other sophisticated equipment. But most of the investment in information technology, analysts say, has been on back-office financial and administrative systems to handle tasks like billing and collections.

At the clinical level, where employees include doctors and nurses, adoption has been slow. Only 13 percent of the nation's more than 6,000 hospitals have any kind of electronic patient record system.

Cost has been a big hurdle. Most hospitals do not make money, so they forgo technology investments that seem to have an uncertain return. And until recently, bedside technology has often been expensive and cumbersome. The spread of light, low-cost hand-held computers has changed that - making it much more practical for the government's Centers for Medicare and Medicaid Services to promote standards for ordering and processing electronic prescriptions.

"We've reached the point where the technology really can have a big impact," said David Lubinski, managing director of health care and life sciences at Microsoft.

The government report was prepared by Dr. David J. Brailer, who was appointed in May as the national coordinator for health information technology, a new post. Health care industry experts see his appointment and the government plan as encouraging steps. But, they note, much will depend on how forcefully the government pursues its goals and how effectively the private sector responds.

"You need the big stick of the government and the innovation and commitment of the private sector," said Neil de Crescenzo, who heads the health care practice for I.B.M.'s business consulting services. "And the real test will be 6, 12 or 18 months down the road. Are the standards being set and implemented, and are these networks being built?"