President launches push for electronic records; funds for project still in question

Washington -- The time has come to bring medical records into the 21st century, says President Bush.

In a speech before the American Assn. of Community Colleges in April, Bush set a 10-year goal of getting most Americans a personal electronic health record that could be accessed and added to by physicians and health practitioners with the patient's authorization.

"The system is antiquated," Bush said. "They should have personal electronic medical files available that accurately and securely keep a patient's medical history."

The president described a secure electronic record that could be accessed online and would include the patients' medical history, prescription information and other vital data. The record could be a basis for transmitting diagnostic imaging, laboratory test results and electronic prescriptions.

Bush plans to name a national health information technology coordinator within the Health and Human Services Dept. to manage the effort. He promised that the federal government would finalize standards for electronic health records by year's end.

"The federal government has got to take the lead in order to make this happen by developing technical standards," Bush said. "Docs talk different languages in different offices, and to have uniformity, there needs to be standards available."

The announcement was greeted with much applause from physicians and health groups, although many expressed concerns about how the plan would come to fruition. "It's great news that the president is promoting this," said American Medical Association Trustee Joseph M. Heyman, MD. "This is a real important development in health care."

Electronic records hold the promise of reducing redundancy of testing, eliminating medication errors and preventing adverse effects from conflicting courses of treatment. Dr. Heyman has used an electronic medical record system in his solo gynecology practice in Amesbury, Mass., since 2001.

"This made it possible for me to run a practice with only a single employee besides myself," he said. "My practice is therefore very efficient. I don't have any charts to pull. Laboratory work and billing are very easy. I'm able to accomplish anything from my desk."

But he also cautions that not all physicians can afford to make the investment in electronic medical records and shouldn't be forced to adopt them.

"One thing that we don't want to see is an unfunded mandate that forces physicians into somehow having to purchase hardware or software to accomplish this, especially in the current environment where the pressures on physicians are so great," Dr. Heyman said. "Doctors feel like they are in a hamster wheel just trying to keep up."

Although Bush's proposed fiscal year 2005 budget would double the funds available for demonstration projects and grants to $100 million, there is no established funding stream to pay for the widespread dissemination of electronic records for patients or doctors.

Congress fails to lead

House Ways and Means Committee Chair Bill Thomas (R, Calif.) said he was disappointed that lawmakers had not been able to establish a health information technology infrastructure to allow health professionals to share data electronically as the financial services industry now does.

Because medical data is being recorded primarily on paper, it is difficult to share information on a given patient or on the health care system in aggregate. As a result, lawmakers and health care officials have little access to health care data that could be used to shape better health care policy. Current health IT proposals, although positive, fall short of what is needed, he said. Thomas believes that concerns about patient privacy have been overblown for political reasons.

"We have failed the average citizen by the political aspect that's been placed on this information," Thomas said. "It just boggles my mind that somebody is more comfortable with thousands of manila folders stuffed with hundreds of pieces of paper on these massive sliding file cabinets in every doctor's office as a comfort that no one is going to be able to look at their health records."

Thomas said he would make another push for getting an IT structure in place but that it was unlikely any health legislation would pass this year.

"I don't blame anybody for not investing in getting rid of all of those manila folders if it's a chunk of money and three years later it's incompatible," he said. "But that ought to be able to be overcome fairly easily if you focused on it."

Members of Congress from both sides of the aisle and both chambers have offered health IT legislation this year. Even ideological adversaries Sen. Hillary Clinton (D, N.Y) and former House Speaker Newt Gingrich have found common ground on the issue.

There are also myriad public and private coalitions working to promote standards and interoperability. An American College of Physicians report said these efforts had amounted to a great deal of smoke but little fire.

"The sheer volume of different initiatives, demonstrations and groups participating make coordination of these activities very difficult, which is why ACP is advocating so strongly for active federal leadership and sufficient startup and ongoing funding to make interoperability a reality," the group said.

Currently, less than 10% of physicians are estimated to be using electronic health records, and few can exchange information.

Charles Safran, MD, president of the American Medical Informatics Assn., called Bush's goal both realistic and attainable.

"The national health information infrastructure will profoundly improve the health of the American people," Dr. Safran said. "Seamless and interoperable transmission of health data will increase efficiency, improve quality of care, reduce medical errors and reduce administrative costs."