I have yet to meet a health care provider, health policy expert, or political leader who has thought about the issue and come out against the idea of electronic medical records. That’s why I’m surprised and disappointed that Congress, the Bush administration, and the medical establishments still haven’t acted to make them a reality.
Almost two years have passed since Sen. Hillary Clinton and I took to the Senate floor—side-by-side –to call for a system of secure, interoperable, privacy-protected medical records for all Americans who want them.
While better record keeping alone won’t fix everything that ails our medical system, just about everyone agrees that no health care proposal—government-centered, market-oriented, or in-between—can move forward until we bring medicine into the information age.
Some background: Even as computers have seamlessly integrated their way into everything from banking to movie rentals, medicine lags behind. Medicine spends the least on information technology—about 3 percent—of any major economic sector.
This does damage to our health care sector: although America spends the most on health care of any country, trains the best doctors, and does the most medical research, our medical system doesn’t provide the best health care.
Researchers at Dartmouth University found that America wastes as much as a third of the $1.8 trillion it spends on medical care — much of the waste comes from disorganization and lack of timely information.
Millions with chronic conditions like diabetes, obesity, and arthritis end up hospitalized, in pain, or dead largely because it has become so difficult for doctors, nurses, and patients to coordinate care. Quite literally, paper kills. Thousands—if not scores of thousands–of Americans die each year as a result of poor quality paper records.
The technology to solve these problems and save lives already exists and we know that it works. The Department of Veterans Affairs, Kaiser Permanente, and Utah‘s Intermountain Health Care have all built impressive electronic medical records systems of their own.
The VA’s computer system, indeed, appears to be a major reason why VA care costs less and provides better health outcomes than Medicare in each of 11 measures that the government uses.
But these systems and others like them still can’t communicate. When VA patients get care at non-VA facilities, doctors have no way to access their records or add tothem.
Likewise, even within the VA and similar systems, it remains a challenge to make sure that doctors all use the same terminology: what one physician calls the “thoracic cavity” another might refer to as the “chest.”
In addition, outdated anti-trust laws make it difficult or impossible for hospitals and doctors to come together and agree on standards. In all of these cases, government can help.
Throughout American history, private businesses and individuals have driven technology forward only after government brought people together to set standards. Railroads, for example, wouldn’t have taken off without government standardizing track gauge so that trains from different companies could share track.
Although private companies, likewise, developed substantially all of the software that people use day-to-day, it took government standard setting to create the underlying standards that describe how computers transfer data across distances on the Internet. Medical records need the same sort of standard-setting effort.
So far, however, a variety of parochial concerns has held up the adoption of a standards setting bill. As a doctor, I’m convinced that my medical colleagues will likely need some sort of incentive to actually begin using the system.
Patients’ groups, hospital administrators, government officials, nurses, technology companies and others all have their own concerns. In time, someone will have to address all of these concerns.
But such concerns—even my own—do not provide a good reason to delay the regulatory and anti-trust changes that everyone already agrees on. Quite simply, the nation can’t afford to wait.
Bill Frist, a physician, is a former majority leader of the United States Senate.
