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Q&A with Stanley Hochberg: I.T. for MDs – Improving patient care

The nation’s economic stimulus package includes $20 billion to accelerate the use of electronic medical records in doctors’ offices. Proponents say computerizing patient data has enormous potential benefits for better healthcare delivery, including quality and timeliness of care. We sat down with Dr. Stanley Hochberg, director of Northeastern’s health informatics graduate program to talk about what it all means in reality.

How would patients benefit from a universal, electronic health information network?

Medicine has gotten so complex that it is becoming difficult for physicians to stay current with all the latest treatments and recommendations. Their days are so busy that they don’t always have adequate time to review a patient’s complete past medical history or look up the latest treatment. Electronic health records can present the relevant parts of a patient’s history and the most up-to-date treatment recommendations right on screen while the patient is in the room. By presenting this information clearly and concisely, electronic health records allow doctors to spend more time listening to and actually taking care of patients, as well as support them in making better treatment decisions. When a patient is referred to another physician, their information can be securely and efficiently transmitted between physicians. This does not always happen in a paper record environment.

Computerizing patient data is nothing new, so what is new about this particular federal plan?

This is the first federal initiative to commit major funding for adoption of electronic medical records in individual practices. Physicians have struggled to afford these expensive systems. Funding to help with the purchase and maintenance of these systems will accelerate adoption significantly. The challenge will be linking up these diverse systems so that patient information is readily accessible wherever they are receiving care.

President Barack Obama explained that this $20 billion investment will lead to ensuring that “within five years, all of America’s medical records are computerized.” Is this a realistic timeframe?

This is an aggressive time frame. There is always a lag between when legislation is passed and when actual funds are disbursed. The installation of these systems can take as long as a year or more. Not all physicians are ready to adopt these systems, even if funds are available. These systems require major changes in day-to-day office processes. Some physicians are not yet ready for that. Seven to 10 years may be a more realistic time frame.

Most large healthcare providers with 50 or more doctors have been using electronic systems to store and use patient data. But more than 70 percent of healthcare practices are small with less than a dozen doctors each and they simply can’t afford investing in expensive technology. What incentives would make it worthwhile for small practices to invest in the new tool?

Financial grants to cover some of the purchase cost for these systems is very important. As practices improve the quality and cost of care with these systems, they should be paid more to support the ongoing costs. Adding bonuses for quality to physician contracts is a good mechanism for doing this.

While the idea of computerizing health records is widely applauded, experts caution about the challenge of implementation. Many call for creating more local organizations called “regional health IT extension centers” to help small practices implement the technology and provide technical support and education. How do these centers work and are they the answer to the implementation challenge?

Unlike large organizations, many physician practices do not have the expertise to select the right system, install it and support it. Organizations supported by state and federal funds can develop training programs for physicians and their staff, and provide consulting support as go through the process of purchase and selection. Physicians need an inexpensive unbiased source for this support. The for profit marketplace will not provide this.

Another challenge being widely cited is privacy protection. What safeguards would be necessary to reach the goal of a universally implemented medical record network with guaranteed patient privacy?

There are electronic standards for healthcare information transfer already in place. Methods to verify the identities of both patients and physicians are also well developed. Most systems also record who has accessed a record and when, in case there is any question of a violation of confidentiality. Given the importance of patient confidentiality, the technology to assure privacy will continue to improve.

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