Topics in Health: Lessons From The Field
Covering Electronic Health Records
Electronic health records (EHRs) have been around in one form or another since the 1960s, but the notion of patient records being stored on computers is only beginning to seep into the public's consciousness. While pretty much every other industry computerized years ago, the vast majority of Americans' medical records remain on paper.
The goal of electronic health records (and health information technology in general) is to make health care safer and more efficient by providing health professionals and patients alike with information to inform decision-making, promote preventive care and reduce duplication.
It sounds simple enough, but health IT is a complex, frequently misunderstood topic. In this essay, I'll provide some background on electronic health records and health information technology, a glossary of terms, and some story ideas, with the goal of helping you better cover this important health and business topic.
Ditching paper charts is not easy, nor is writing about the conversion. The central story is not the technology itself, but rather how health information technology will transform care. "It's really a matter of change management rather than technology," Dr. David Blumenthal, the Obama administration's national coordinator for health IT, explained in November 2009.
Online health records for all – "in 10 years"
First, some background: in 2004, President George W. Bush called for "most Americans" to have electronic health records within 10 years and created the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services to help make it happen. One early project of the office was the attempted conversion of VistA, the EHR long in place at the Department of Veterans Affairs, for use in small medical practices. The EHR, which was difficult to install in most doctors' offices, never made it past a beta version before federal officials dropped the project.
Health IT subsequently drifted in and out of the national spotlight over the next several years, but didn't garner much coverage in the mainstream press unless there was a local angle, such as a hospital installing a system. As a longtime reporter on this beat, it has been a challenge to "sell" this story outside the trade press. But now that health information technology is a major story, with plenty of interesting national and local angles, I've noticed more reporters scrambling to grasp this difficult subject.
So what's finally turning arcane health information technology into a mainstream news story? Two things: National health reform and the federal stimulus bill.
Health Reform: Can Better Health IT Lower Costs and Improve Care?
Now that health insurance reform legislation[NV1] has passed, I hope mainstream media will turn their attention to a major health information technology story: greater access to health care does not guarantee good care, so it won't matter much whether government or private companies administer health plans for millions of new enrollees as long as fee-for-service remains the dominant payment model.
The perverse reality is that mistakes can be good for business. Medical errors and other complications lead to more hospitalizations and longer stays. Both the fear of being sued and the inability to access previous results cause doctors to order extra tests, without regard to medical prudence.
Health IT can help prevent errors by offering what's known as clinical decision support - computerized alerts recommending best practices and warning against harmful actions, such as prescribing a medication to which a patient is allergic. EHRs, if properly connected to laboratory systems, make test results more readily available so there is less need to re-order procedures. A good EHR should keep a record of every instruction a doctor gives to a patient so there is no question what was or was not communicated, in case of a malpractice claim.
From the perspective of a health IT reporter, health reform started not with the bills President Obama signed in March 2010, but more than a year earlier with the passage of the $787 billion stimulus bill, also known as the American Recovery and Reinvestment Act. The 2009 legislation contains an estimated $25.8 billion for health IT, mostly in the form of incentives [NV2] for doctors and hospitals to adopt electronic health records. Those that have not ditched their paper charts by 2015 face lower Medicare and Medicaid reimbursements.
Insurers and employers that provide health benefits tend to reap the greatest financial rewards from EHRs, so there has been little incentive for the actual providers of health care – physicians and hospitals - to invest in technology. The stimulus is supposed to change the paradigm by rewarding providers that demonstrate "meaningful use" of EHRs beginning in October 2010 for hospitals and January 2011 for physician practices.
According to rules proposed at the end of 2009, EHRs should provide clinical decision support, doctors and nurses should enter orders electronically, patients should be able to get a copy of their medical records on demand and users should be able to share data between facilities and organizations. The requirements will get tougher in 2013 and again in 2015; providers eventually will have to prove that they follow nationally recognized standards of practice.
As electronic health records – and subsets of them like personal health records – become more of a hot topic for mainstream media, it's important to learn the lingo and get your facts straight.
Know your acronyms: a cautionary tale
Here's what can happen if you don't: On Dec. 2, 2009, a website called eSecurity Planet published a story about a privacy watchdog organization publishing a pre-emptive strike against personal health records, a subset of EHRs that has virtually zero market traction to date.
The eSecurity Planet story confused consumer-oriented personal health records for "electronic medical records" and wrongly reported that the stimulus is paying for billions in "electronic personal health records (PHRs)." The stimulus is supporting EHRs, a much broader category. Additionally, the story, like far too many others I've read, referred to the much-hyped Google Health and Microsoft HealthVault platforms as market leaders. They are nothing more than early-stage products from big names in the consumer arena, not established health IT powerhouses.
Look past the hype, learn the terminology and talk to people on the front lines. Go to the chief information officer and nursing shift managers of a local hospital. Physicians in private practice should have plenty to say as well.
This subject is often tough to grasp, so don't be afraid to ask seemingly simple questions. I've been covering health IT since 2001, and I still frequently need detailed explanations.
Story ideas for your community
As implementation of national health insurance reform begins and EHR money starts flowing from the stimulus bill, I hope you'll consider these story ideas for your community.
1. Who owns your EHR[NV3] ? Should you be concerned about it being used as a source of information for pharmaceutical researchers or medical marketers?
2. What is your local hospital or large medical group doing to get stimulus money for EHR development? What differences might patients see as a result?
3. How will the physician office visit change as a result of computerization? Will patients be asked to complete medical history forms online rather than filling out the ubiquitous clipboard each time they go to the doctor? Will nurses and physician assistants be able to provide services once the exclusive domain of physicians because if they have access to more complete patient information?
4. How might patients get better preventive care if medical practices are able to generate, with the help of EHRs, automatic reminders for recommended screening based on age, gender and health risk factors?
Neil Versel is a Chicago-based freelance healthcare journalist, specializing in health information technology, healthcare quality, hospital/physician practice management and healthcare finance. He edits the online newsletters FierceHealthIT, FierceEMR and FierceMobileHealthcare and is a regular contributor to CMIO Magazine.