Health care's digital gamble

Privacy fears rise as records head for U.S. network

March 23, 2009|By Matthew Hay Brown | Matthew Hay Brown,

As he looks for ways to pay for universal health coverage, President Barack Obama is placing a multibillion-dollar bet on electronic health records.

The goal is to get all of the nation's doctors to make the move from clipboard to computer by 2014, thus creating a national health information network that proponents from across the political spectrum say will improve care, advance medical knowledge and save the country tens of billions of dollars annually.

That future can be glimpsed in Dundalk, where H. Edward Parker has been a patient at Johns Hopkins Community Physicians for decades. Now the retired high school principal sits down next to his doctor as they use a computer program to review his history, look up the latest research and discuss new courses of treatment.

"We have much more meaningful communication" since his doctor's office adopted electronic health records in early 2007, Parker said. "It has made me much more of a participant in my own wellness."

Obama has promised to spend $50 billion over five years on health information technology and fulfilled more than a third of the pledge with $17.2 billion in the economic stimulus package to help doctors with the costs of adopting electronic records, the foundation of the national network.

"We've got the most inefficient health care system imaginable," Obama said last month. "We're still using paper. We're still filing things in triplicate. Nurses can't read the prescriptions that doctors have written out. Why wouldn't we want to put that on an electronic medical record that will reduce error rates, reduce our long-term costs of health care and create jobs right now?"

The enthusiasm is not unanimous. Privacy advocates warn that the characteristics that make computerizing patient records attractive to health care providers - the wealth of personal information and the ease with which it can be accessed - also make the technology ripe for potential exploitation by employers, insurers and others. There is already a market in which medical data, typically gleaned from insurance records, is bought and sold.

"The problem is that the more data that's out there - and it's just going to mushroom - the more difficult it is to keep that private," said Ashley Katz, executive director of the watchdog group Patient Privacy Rights. "Yes, we can do really, really great things with health [information technology]. We can also do really bad things with it."

Dr. Robert M. Kolodner, a psychiatrist and the national coordinator for health information technology, says that patient privacy "is something that we can never afford to forget."

"We have to build it into the entire system - the hardware and the software and the networks - from the very beginning," he said.

"On the other hand," said Kolodner, a Baltimore native, "the safest, the most secure system is one that doesn't move any information. And that doesn't help us, either."

There are other concerns surrounding the technology, ranging from the temporary dips in productivity as doctors make the transition from paper charts to computer files to questions about longer-term impacts on the traditional doctor-patient visit.

Dr. Pamela Hartzband and Dr. Jerome Groopman, physicians in Boston and professors at Harvard Medical School, warn that technology can divert attention from the patient.

"One of our patients has taken to calling another of her physicians 'Dr. Computer' because, she said, 'He never looks at me at all - only at the screen,' " Hartzband and Groopman wrote last year in The New England Journal of Medicine. "Much key clinical information is lost when physicians fail to observe the patient in front of them."

Obama has identified computerized records, which a patient can "carry" from doctor to doctor, as a key source of savings to help fund his promised health care reform. Proponents see the savings coming principally from some combination of duplicate tests not performed, drug allergies and interactions avoided, and what Kolodner calls "doing the right thing the first time."

The $787 billion economic stimulus package included money for both ends of a system that is to link individual electronic health records to the national network. In addition to the $17.2 billion to help the 80 percent of physicians not currently using electronic health records with startup costs, the package also includes $2 billion in grants and loans to develop the national infrastructure.

In Maryland, officials have directed two groups to develop plans for a statewide health information exchange. Officials are reviewing those plans, as well as lessons learned by other states.

Some health care organizations are ahead of the curve.

In the Wyman Park office of Johns Hopkins Community Physicians, Dr. Gary J. Noronha taps out a code on a computer keyboard. On the screen appears the medical information for a 38-year-old man with diabetes and hypertension.

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