Federal health officials recently said that expanded nationwide use of
health information technology (HIT) by physicians and medical facilities is
critical to improving patient care and controlling spiraling health care
costs. They expect a massive federal funding program to spur widespread
adoption of such electronic record systems by physicians, whose resistance has
limited the use of such systems.
Widespread adoption of HIT, including electronic medical records (EMRs),
will spur improvements in acute care, chronic care, and preventive care,
according to David Blumenthal, M.D., national coordinator for health
information technology at the Department of Health and Human Services.
During an online briefing in August, Blumenthal discussed his experience
with HIT systems in private practice during the last 10 years. He credited HIT
with preventing the loss of notes and records that can occur with paper
documents, as well as with reducing inefficiencies. For example, he said,
physicians who treat older patients—who are more likely to receive care
from multiple clinicians—would benefit from a unified electronic record
that would note whether the patient already had undergone a needed test.
Similarly, HIT systems could facilitate better care coordination among
physicians and alert them if they are about to prescribe medications that
conflict with those prescribed by other clinicians.
"It is important for clinicians to be able to share
information," Blumenthal emphasized.
In addition, said Mary Wakefield, R.N., administrator of the government's
Health Resources and Services Administration, improved care coordination
facilitated by expanded use of HIT should help control health care costs,
which have grown to 17 percent of the U.S. economy. Better information
exchange between clinicians will help detect serious illness at an earlier
stage and allow treatment before conditions advance and more costly treatments
The push by federal officials to urge broad physician adoption of HIT
systems seeks to overcome long-standing clinician resistance to them on the
basis of cost concerns and their ability to protect the privacy of patient
Only about 12 percent of physicians have adopted HIT systems, according to
a 2008 Congressional Budget Office report. Another study, published on July 3,
2008, in the New England Journal of Medicine, found that only 4
percent of physicians had adopted fully functional EMRs, and those who had
tended to be in larger practices (Psychiatric News, August 1,
The federal government has made widespread HIT adoption a major policy
priority. The centerpiece of the initiative is a federal program to reimburse
physicians up to $44,000 over five years—beginning in 2011—for
their costs in installing electronic record systems. The program, created in
the American Recovery and Reinvestment Act of 2009 (ARRA, PL 111-5), includes
$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.
"With that funding and physicians' commitment to put patient care
first, this is going to happen," Blumenthal said. "And it's the
right thing to do."
The federal law also includes a mandate for regulators to develop strong
patient-privacy protections. These aim to address the concerns of physician
and patient-advocacy organizations that putting patient records into a system
accessible to many authorized users would exponentially increase the risk of
privacy violations. For instance, in 2008 health organizations reported 97
data breaches, up from 64 the previous year. A much larger jump in reported
breaches is expected this year, in part due to a new California law that
requires reports of unauthorized disclosures of electronic medical records,
according to media reports.
"We are leaving no stone unturned in trying to keep this information
private and secure," Blumenthal stated.
In 2008 congressional testimony, Robert Plovnick, M.D., M.S., director of
the APA Department of Quality Improvement and Psychiatric Services, cited
lingering privacy concerns of psychiatrists and other physicians in limiting
their switch to HIT systems. Protecting the confidentiality of the
patient-physician relationship is particularly critical in psychiatric care
because of concerns about employment discrimination and social stigma toward
people with mental illness, he noted.
Critics of the HIT effort also have questioned the ability of electronic
patient records to reduce health care costs.
"I don't think it will save a bundle of money," said Uwe
Reinhardt, the James Madison Professor of Political Economy and Economics at
Princeton and a leading expert in health care financing, at a June briefing."
It will initially cost more [to clinicians] to put this in place, but I
think it will enhance the quality of the treatment because it's much better
Any cost savings from HIT use likely will come through the collection of
electronic patient data by health care researchers looking for promising
treatments and potentially dangerous medications, Reinhardt said.
Federal health officials echoed the research-based potential of the
electronic patient record and assured the public that regulations will mandate
that all personally identifiable patient data are removed before such records
are shared with researchers.
ANew England Journal of Medicinearticle by
Blumenthal on the challenges of HIT is posted at<http://content.nejm.org/cgi/content/full/NEJMp0901592>.▪