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Government News
Federal Officials Tout Benefits of Electronic Records
Psychiatric News
Volume 44 Number 18 page 7-33

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 are needed.

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 information.

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, 2008).

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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."

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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 informed."

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>.

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