Growing Pains As Doctors' Offices Adopt Electronic Records
Information technology has transformed much of the American economy, but its use in health care still lags, especially when it comes to electronic medical records.
Here's an example: The state of Colorado runs a computerized registry where any provider who gives a child a vaccine can report that information. The system should help kids stay current with their immunizations.
But the state's computer system isn't compatible with most of the ones doctors use, so many practices don't update the central database because it's just too much extra data entry, says Dr. Allison Kempe, director of the Children's Outcomes Research Program at the University of Colorado School of Medicine. That means doctors and researchers like her, who try to keep kids' immunizations on track, can't rely on it to make sure a vaccine isn't missed or given twice.
This is just one instance of the digital disconnect that's holding health care back, says Dr. Art Kellermann, a policy analyst with the Rand Corp. He says the ability for doctors to easily share information is the exception in the U.S., not the rule.
Kellermann co-authored an article in this month's Health Affairs, reflecting on a study from 2005 that said information technology could save America $81 billion a year by making health care more efficient. He found actual savings have been scant and that many doctors complain electronic records make them less efficient.
The result is that the health care industry isn't benefiting from the computer networks that have transformed other industries, such as manufacturing, retail and banking.
"You can take your ATM card and go to any ATM in the country" to withdraw money or transfer funds among accounts, Kellermann notes. "You can't do that with health information technology today."
According to a survey from the Centers for Disease Control and Prevention, while 72 percent of office-based physicians use some sort of electronic system in their practice, only 40 percent of practices meet the definition of even a "basic" system.
"People talk about the ATM, [but] that's seven data elements, and they charge you $2.50 for shipping those seven data fields over. We're talking thousands of data fields around things that are life and death," says Farzad Mostashari, the national coordinator for health information technology at the Department of Health and Human Services. His office is charged with leading American medicine's digital transformation.
That office meets constantly with software vendors — on average, one meeting every 3 1/2 hours for the past three years, Mostashari claims — trying to hammer out the industry standards necessary to make health information as easy to share as bank records or other commercial data.
The number of doctors and hospitals using electronic records has doubled in the past two years, Mostashari says, thanks in part to federal stimulus money for doctors who adopted electronic records. He admits there are growing pains but says the government's strategy is helping, though it will need six more years before it can show significant savings.
Both he and Kellermann agree that patients would get better care, at lower cost, if health care systems could share patient records easily. But that won't happen until doctors and hospitals start getting paid for being smart about IT. Right now, duplicative testing also means duplicative payments.
But Kellermann is optimistic the Affordable Care Act's payment reforms can change that.
"As we shift American health care and start paying for the best quality care and the best outcomes, rather than who does the most stuff, who orders the most tests or who does the most operations, then I think you'll see IT becoming a tool for efficiency and high performance," Kellermann says.
This story is part of a partnership between NPR, Colorado Public Radio and Kaiser Health News.
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Transcript
ROBERT SIEGEL, HOST:
Information technology has revolutionized much of the American economy. Retailers keep all kinds of computerized records, for example, everything from their customers' purchases to their inventory. But one industry lags noticeably in the information age, health care providers. A majority of American doctors weren't even using electronic health records until last year. The White House has made IT a priority as part of its healthcare overhaul.
And as Eric Whitney of Colorado Public Radio reports, it's a big lift that's going to take some time.
ERIC WHITNEY, BYLINE: Dr. Allison Kempe is a researcher at the University of Colorado. Her challenge is keeping kids' immunizations on track. That's hard if children see different doctors every year.
DR. ALLISON KEMPE: That happens a lot. They get seen at one site, then their insurance changes, they go to another site.
WHITNEY: Colorado has a place to pull all those scattered records together, a computerized central registry where any provider who gives a kid vaccine can enter that information. So if the kid shows up in a different clinic later, staff can log in to the registry and make sure they're not doubling up or missing critical booster shots.
But here's what drives Kempe crazy. The state's computer system is incompatible with most of the systems doctors use. So even though a lot of clinics now have electronic records systems, they don't update the central database. It's just too much extra work.
KEMPE: A very small minority of practices can actually automatically upload their records. Most practices are having to do double data entry where they enter information manually into the registry.
WHITNEY: And if it's not current, doctors can't rely on it as a kids' vaccination record. This is just one small example of the digital disconnect that's holding healthcare back, says Dr. Art Kellerman, a policy analyst with the RAND Corporation. He says the ability for doctors to easily share information is the exception in America, not the rule. The result is that the health care industry isn't benefitting from the computer networks that have transformed industries like manufacturing, retail and banking.
DR. ART KELLERMAN: You think about it. You can take you ATM card and go to any ATM in the country - and in many cases in other countries - and withdraw money or even move your accounts from one account to another. You can't do that with health information technology today.
WHITNEY: Kellerman published an article in this month's Health Affairs reflecting on a study from 2005 that said information technology could save America $81 billion a year by making healthcare more efficient. He found actual savings scant and that many doctors complain electronic records make them less efficient. Some of Kellerman's criticism is valid but some of it's not, says the doctor charged with leading American medicine's digital transformation.
DR. FARZAD MOSTASHARI: People talk about the ATM, and that's seven-data elements, and they charge you 2.50 for shipping those seven data, you know, data fields over. We're talking thousands of data fields around things that are life and death.
WHITNEY: Dr. Farzad Mostashari is the White House's National Coordinator for Health Information Technology. His office meets constantly with software vendors. They're trying to hammer out the basic industry standards necessary to make sharing health information as easy as bank records or other important information.
MOSTASHARI: But we have actually these meetings on average every three-and-a-half hours for the past three years.
WHITNEY: Mostashari says the number of doctors and hospitals using electronic records has doubled in the last two years. He admits there are growing pains but says the government's strategy is helping.
MOSTASHARI: It is a work in progress. And, you know, it's going to be hard work. But it is way, I think, too soon to be saying, oh, this is such a disappointment.
WHITNEY: Mostashari says it'll be another six years before the government's IT strategy starts showing significant savings. Both he and Kellerman agree patients would get better care at lower cost if healthcare could share patient records easily. But that won't happen until doctors and hospitals start getting paid for being IT smart. Right now, duplicative testing also means duplicative payments. Kellerman is optimistic the Affordable Care Act's payment reforms can change that.
KELLERMAN: As we shift American healthcare and start paying for value rather than volume, start paying for the best quality care and the best outcomes rather than who does the most stuff, who orders the most tests or who does the most operations or who orders the most consultations from other doctors, then I think you'll see IT becoming a tool for efficiency and high performance.
WHITNEY: Kellerman says there will be setbacks, but the health industry has got to catch up. For NPR News, I'm Eric Whitney in Denver.
SIEGEL: And that story is part of a partnership of NPR, Colorado Public Radio and Kaiser Health News.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
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