The result of all these grand declarations: Ninety percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records.
"Health care is at least a generation behind the rest of society in terms of technology," says David Merritt, director of the Center for Health Transformation, a think tank based in Washington. "Doctors and hospitals don't use the technology we take for granted everywhere else."
The reasons for this lag are many: a colossal, inertia-filled health-care system; a paucity of good software; no incentives to adopt new technology; and a lack of government leadership. There is also concern, which advocates of digitization say is overstated, about the security and privacy.
But almost everyone agrees that moving from paper to bits will improve health care. Numerous studies and reports have found that electronic health records can reduce medical errors, save lives and save perhaps hundreds of billions of dollars if all doctors and hospitals went digital and were networked.
Electronic health records also speed service. After the emergency room at Beth Israel Deaconess Hospital in Boston went completely digital, the average length of stay dropped by 45 minutes.
"You can get any information, on any patient, when you want it," says John Halamka, an ER doctor there, as well as the hospital's chief information officer who oversees the e-records of 3 million patients. "There's no more 'I can't find this patient's chart.' "
But the transformation hasn't spread far, at least in the United States. In Denmark, 90 percent of the health system is computerized. Germany completed its health-care digitization two years ago.
"Pretty much every country in the developed world is doing better than we are," says David Lansky, director of the health program at the Markle Foundation, a technology think tank.
Of course, unlike every other developed country, the United States does not have nationalized or otherwise closely coordinated health care. The U.S. system is also much larger and more unwieldy than any other: a $2 trillion industry, staffed by 700,000 doctors, most of them essentially small, independent business people who are generally paid not by their customers but by insurance companies.
"It's such a convoluted system," Merritt says. "When you think about changing that kind of behemoth, it's daunting."
Even so, he and other experts say, the federal government could do much more to encourage doctors and hospitals to leave paper behind.
"It's hard to believe that America lags behind the world in adoption of the information technology that can save lives and make health care more affordable – yet that's exactly the case today," Sen. Edward M. Kennedy, D-Mass., who has been pushing the issue for years, said through a spokesman. "Congress and the administration should make a commitment to bringing the nation's health system into the information age."
One key is incentives. For an individual doctor or a small practice, switching from paper to digital costs between $40,000 and $60,000. For most doctors, this is a lot of money: The average physician pulls in about $150,000 a year. And the savings from going digital mostly accrue to the insurance companies, Merritt said.
The government says it has picked up the pace. "We've made good progress over the past couple of years," says Department of Health and Human Services official Herb Kuhn, who is heavily involved in health information technology.
Last year, the federal agency began a program that offered to cover 85 percent of hospitals' cost for going digital. And in late February, the department rolled out a pilot program that will pay most of the costs for 1,200 small practices to install electronic records. That program is budgeted to spend up to $150 million over the next five years.
If that sounds like a lot, it isn't, many experts say. Lansky points out that the few thousand doctors affected by the program are a tiny percentage of the total. He says the government should do much more.
"These are small businesses," he says. "To ask individual businesses to spend $40,000 on a technology that doesn't make them money is not fair."
Some major institutions have decided on their own to modernize. The Department of Veterans Affairs, which for decades had a reputation as a backwater of bad care, has transformed itself. It is now fully electronic and networked.
Kaiser Permanente, which takes care of almost 9 million Americans, is spending $3 billion to digitize itself: 430 clinics and offices, as well as 32 hospitals.
But these islands exist amid a sea of medical paper.
Meanwhile, other countries are moving ahead. In 2002, the United Kingdom allocated more than $11 billion to computerize its health system. Canada, which began the process a decade ago, is spending a billion dollars and expects to be halfway done by next year. According to a 2006 study, Britain is spending almost $200 per citizen on its e-health-care system, while Canada is putting up more than $30. In the United States, meanwhile, it's less than a dollar.
One development that probably will spur digitization: Several big companies see electronic health records as a huge moneymaker and are now trying to entice consumers to upload and store health information online.
Microsoft has launched a site called HealthVault and has formed partnerships with the Mayo Clinic and New York Presbyterian Hospital, among others; Google's version, Google Health, announced a venture with the Cleveland Clinic to computerize records of as many as 10,000 patients. And Revolution Health, AOL founder Steve Case's startup, has signed up "tens of thousands" of consumers for its online service.
None of the sites charge fees – they plan to make money from Web advertising. If enough people decide to store health records online, the revenue could be enormous. "As people are able to do the same things online with health care that they do with travel and banking, the pie gets very, very large," says Sean Nolan, the chief architect of HealthVault.
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Autor(en)/Author(s): David Kohn
Quelle/Source: Nashua Telegraph, 30.03.2008
