Physician, wire thyself

In fact, all of those innovations are already being offered, on a very limited (and sometimes experimental) basis, by a handful of doctors and hospitals today. But how and when will these services become available to all of us?

First, electronic health records, whether at the doctor’s office or on your home computer, will require extremely good security to convince patients that their privacy is fully protected. But this may not prove to be a major hurdle. Experts believe that health-care records won’t attract the same level of organized criminal hacking as have financial records: a cholesterol count isn’t quite as valuable as a credit-card number. And federal regulation called HIPAA, enacted a decade ago, already enforces stringent controls on the handling and security of health data in preparation for the brave new world of digital medical information.

A more serious sticking point is in the doctor’s office, where computers may now schedule the appointments and track the billing, but that’s usually where it ends. Only about 10 percent of physician’s offices — generally larger, multiple-physician practices — use electronic health care records.  Those without aren’t in a hurry to upgrade. 

Doctors aren’t like, say, insurance agents, where the central office says “computerize” and so it is.  Older physicians have their ways of practice well established — and even if they want to change, converting existing paper into digital isn’t easy or cheap.  On top of that, the cost savings in electronic health records are distributed across the whole healthcare infrastructure, and may not appear as immediate benefits to the physician’s own bottom line.

Then there’s the ever-troublesome question of standards: a national system of interchangeable health records will require standard formats to ensure one office can read another office’s files. As it is, some current computer standards date back to the mainframe era.  And the problem is larger than computer code compatibility — there are still no national standards for medical terminology itself; laboratory procedures and results, for example, can have different names in different parts of the country.  (There’s actually a plus side to the primitive state of medical information standards — once adopted, the new versions will be state-of-the-art and fully adapted for the Internet.)

Observers increasingly suggest that the federal government — which already pays over 40 percent of the health care costs in the U.S. — needs to help solve both the funding and standards problems. Congress will look at several bills this fall that provide funds for pilot computerization programs and also require standards for any clinical equipment purchased with federal funds.  But it will take more than that.  In August a team of experts writing for the Annals of Internal Medicine estimated that a full national health information system could be put in place for about $156 billion.  Although that sounds like a big number, it’s only two percent of current annual healthcare spending—and with the potential savings in the trillions, that’s a great return on investment. The current spending projection, however, is only a third of what is required.

There are clearly enormous social and political challenges involved in overhauling the American healthcare system, and so far progress has been slow.  But with trillions of dollars in savings available simply by upgrading to the information technology that the rest of business takes for granted, perhaps it’s time for the health care industry to write itself a prescription for a major dose of new technology. 

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