The physician charged with implementing a $17 billion federal incentive
program that will reimburse physicians for some of the costs of electronic
health records recently highlighted problems that a national record system is
likely to encounter.
David Blumenthal, M.D., who was appointed as the national coordinator for
health information technology (HIT) at the Department of Health and Human
Services in March, will oversee the implementation of an unprecedented federal
effort to spur nationwide HIT adoption—including use of electronic
medical records (EMRs) and e-prescribing—by clinicians and hospitals. In
a commentary published April 9 in the New England Journal of
Medicine, Blumenthal highlighted some of the difficulties facing such a
The former Harvard Medical School professor wrote that "huge
challenges" in efforts to establish a national EMR system could include
low adoption rates for the technology, potential technical problems, high
initial set-up costs, and data-privacy concerns by both clinicians and
The patient-privacy concerns were highlighted by a telephone survey of a
nationally representative sample of 1,238 adults by the Kaiser Family
Foundation in March; 76 percent of respondents said they believed it would be
very or somewhat likely that an unauthorized person would be able to access
their medical record.
The privacy concerns and other challenges will need to be addressed by
Blumenthal in his key role in implementing the federal program to reimburse
physicians up to $44,000 over five years for their costs in installing digital
record systems. That role was created by the American Recovery and
Reinvestment Act of 2009 (ARRA, PL 111-5), which included $17 billion in
grants to encourage the use of EMRs, HIT (which includes the software and
hardware needed to operate EMRs), and e-prescribing (Psychiatric
News, March 20). The law also includes penalties for physicians who have
not installed EMR systems by 2015.
Cost estimates for the adoption of HIT systems vary widely. The Agency for
Healthcare Research and Quality concluded in 2005 that the average cost to
place EMRs in practices overall was about $32,600 per clinician, while smaller
practices were likely to incur a somewhat higher cost—about $37,200 per
clinician. A March analysis by Avalere, a health care consulting company,
concluded that a solo or small-group physician practice implementing an EMR
system could spend an estimated $124,000 over five years, or $80,000 more than
the maximum federal reimbursement.
Eligibility for federal reimbursements will be limited to those who use"
certified" EMR systems, and that certification process and its
criteria will be determined by Blumenthal's office. His role is expected to
supersede the work of the Certification Commission for Healthcare Information
Technology (CCHIT), which has been working with the health care
industry—including physician groups—to develop HIT standards
(Psychiatric News, January 5, 2007). The economic-stimulus law
describes the CCHIT standards as a guide for future federal certification
standards—due to be finalized by 2010—but those standards will not
be constrained by CCHIT decisions.
Blumenthal wrote that many EMRs certified through the CCHIT process are
neither user friendly nor designed to meet the stimulus law's goal of
improving quality and efficiency in the nation's health care system.
"Tightening the certification process is a critical early
challenge" for the national HIT coordinator, he said.
The push toward a nationwide HIT system, which the stimulus law is designed
to accelerate, has been driven by the belief that the technology can improve
health care efficiency, reduce costs, and boost the quality of care. HIT
advocates maintain that an interoperable system for exchanging patient data
among physicians' offices, hospitals, and public agencies will reduce medical
errors and provide alerts about dangerous medication interactions.
However, some HIT experts have warned that poorly managed and badly
designed systems could increase risks for patients through inadvertent loss of
their medical data or poor system interoperability. Problems with EMRs also
could arise from clinicians' trying to install the systems too quickly and
without adequate technical support.
Blumenthal's commentary, "Stimulating the Adoption of Health
Information Technology," is posted at<http://content.nejm.org/cgi/reprint/360/15/1477.pdf>.
The Web site of the Office of the National Coordinator for Health Information