Big Challenges Await Health-Records Transition

The physician in charge of the federal government’s massive push to move health care to electronic records from paper files faces “huge challenges” as he starts his new job in Washington this week.

That phrase comes from a paper David Blumenthal himself published recently in the New England Journal of Medicine. He cited low adoption rates, high costs, technical complexities, and physician and patient concerns about privacy.

Some other experts have warned that systems that are poorly designed or badly run can jeopardize patient safety. They are calling for more regulation or stricter standards for certification, arguing that the risks are heightened by limited public oversight of the systems.

“They do far more good than harm, but we can’t sit here and blindly believe that they are error-free,” says Dale Sanders, chief information officer for a group of more than 600 physicians associated with Northwestern University.

Dr. Blumenthal said Monday that problems can arise from trying to install systems too quickly and without proper support. He called technical assistance a “critical factor” in reducing risks.

Dr. Blumenthal and other health IT proponents argue that electronic systems are essential to containing costs and improving the quality of health care. The systems include not only the basic information currently stored on paper records in doctors’ offices and hospitals, but also safety features such as alerts that warn doctors if a patient is being prescribed two drugs that can interact in a dangerous way. Eventually, the systems are supposed to allow information to be shared electronically between doctors’ offices, hospitals and public agencies.

Proponents say the systems reduce wasteful spending, such as by reducing redundant tests, and generate information on how doctors and hospitals fare on quality measures such as giving appropriate tests at the right time. But most doctors and hospitals have yet to adopt the systems, which can cost tens of thousands of dollars for a single physician and millions of dollars for a hospital.

That may soon change. The federal stimulus bill promises billions of dollars in incentive payments to doctors and hospitals that buy and use the systems, with penalties starting in 2015 for those who don’t make the switch.

Some studies have suggested the systems reduce the risk of medical errors. But there also are instances of new technology creating problems.

Children’s Hospital of Pittsburgh initially saw a rise in the death rate for certain patients after computerizing its order-entry system, perhaps because it took longer to begin treatment for some patients, according to a study published in the journal Pediatrics in 2005. The hospital’s current chief medical-information officer called the study “flawed,” adding that the hospital’s mortality rate has fallen significantly since the system was installed.

An AIDS patient was wrongly told he had skin cancer on his neck because a test result for another patient was associated with his electronic record, according to a report this month in an online journal published by the federal Agency for Healthcare Research and Quality. Doctors quickly recognized the error in that case.

The Joint Commission, which accredits the nation’s hospitals, last year called on hospitals to be “mindful of the safety risks and preventable adverse events” that can be created or perpetuated by new technology.

Risks are sometimes created not by the systems themselves but by the way they are installed and the way staff is trained, said David Collins of the Healthcare Information and Management Systems Society, a nonprofit whose members include the biggest companies selling health-IT systems. “It’s not plug and play,” he said. “It’s not like going to Best Buy and getting Windows.”

The stimulus bill says doctors and hospitals must use “certified” electronic systems to qualify for incentive payments, but the job of establishing certification criteria will fall largely to Dr. Blumenthal, named to the post from Harvard Medical School last month.

Major systems on the market now are certified by the Certification Commission for Healthcare Information Technology, a group that has operated with a combination of federal funding and fees from companies that apply for certification for their systems.

CCHIT certification is based largely on whether a system can exchange information with systems sold by other companies, and on whether a system includes certain functions.

But simply having a function isn’t enough, Dr. Blumenthal said: “We need to ensure that physicians can actually use it.”

Mark Leavitt, CCHIT’s chairman, says the group is considering adding the real-world experiences of end users into certification decisions. The stimulus legislation doesn’t specify whether CCHIT should be the group to certify electronic-records systems, but Dr. Leavitt says the group is open to modifying its certification requirements.

Dr. Blumenthal wouldn’t comment on whether CCHIT will remain the key group for certification

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