Ricardo Alonso-Zaldivar, AP
America may be a technology-driven nation, but the healthcare system's conversion from paper to computerized records needs lots of work to get the bugs out, according to experts who spent months studying the issue. Hospitals and doctors' offices increasingly are going digital, the Bipartisan Policy Center says in a report, but there's been little progress getting the computer systems to talk to one another in order to exchange data like financial companies.
"The level of health information exchange in the U.S. is extremely low," the report says. At the consumer level, few people maintain a personal health record on their laptop or electronic tablet, partly due to concerns about privacy, security and accuracy that the government hasn't resolved. "How will sensitive health data be kept confidential and secure in digital data-sharing environments?," the report asks. "Many consumers ... are waiting for a reassuring answer to this question."
The report offers a window on progress toward a goal set by President Barack Obama, and President George W. Bush before him, that everyone in the United States should have an electronic medical record by 2014. While making no predictions, the report offers a collection of details indicating that the goal is a long shot at best.
"Will 100 percent of our nation have electronic health records by 2014?," asked Janet Marchibroda, who directs the center's health technology initiative. "I would say getting to that last mile is difficult." She expects the majority of hospitals and doctors to meet the goal, but it's another matter when it comes to consumers. The report, more than six months in the making, was produced by a panel representing hospitals, doctors, insurers, consumers and technology companies. The review was led by two former senators with ties to the healthcare industry, Democrat Tom Daschle of South Dakota and Republican Bill Frist of Tennessee.
The government has committed up to $30 billion to encourage this shift, mostly through incentive payments to hospitals and doctors that were authorized in 2009 under Obama's economic stimulus law. Payments started flowing last year.
The report found that five percent of eligible doctors received payments last year, while about 33 percent had registered with the government that they intend to qualify. Overall, about one-third of doctors' offices had some form of electronic records last year, compared with one-fourth in 2010. Among hospitals, 32 percent received the incentive payments last year, the report said, while 61 percent notified the government they intend to qualify.
Those are signs of momentum, but the report found little progress in devising ways for the different computer systems to communicate with each other. Part of the problem is that there isn't much financial incentive for competing healthcare providers to share information. If an emergency room orders a test on a patient that a family doctor had run a week ago, the hospital gets paid for it. If the emergency room doctor relies on the test results from the family doctor, that's less revenue for the hospital.
"Health information exchange will not occur at optimal levels ... without a viable, sustainable business model," the report said. Only from seven to 11 percent of individuals have a personal electronic medical record. Some early adopters still run into problems with basic tasks such as downloading test results, renewing prescriptions online or scheduling appointments.
The report also says the government must address gaps in privacy protections. For example, a federal health privacy law that applies to hospitals, doctors, insurers and data transmission companies doesn't apply to companies that market electronic medical records directly to the public. "This uneven coverage of federal health privacy law can be confusing for consumers and contributes to reluctance," the report said.