Obama's national health records system will be costly, daunting

But an electronic health records system could save the nation $300B a year

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Underwood, director of government and industry affairs at Siemens Medical Solutions, believes the bulk of money spent by the Obama administration should go toward creating a monitoring system to ensure hospitals and private practices are using EHR systems -- and they should receive money not only to prime the pumps but as a reward for using EHRs.

For example, if hospitals show they are using a physician order-entry work system or electronic prescription service, they would get funding to continue those services or upgrade them.

Underwood said U.S. health care providers also need to standardize on "evidence-based order systems" -- electronic templates that spell out how patients receive treatment that meets best practices for specific problems. For example, a patient who leaves a hospital after surgery for a heart attack would automatically be prescribed aspirin as part of the post-operative treatment.

"We're trying to put in place evidence-based standards to reduce variation in care," she said. "Vendors have built a lot of technology to ensure processes occur in a proper way."

Brailer, the former national coordinator at Health Information Technology, agreed with Underwood, saying market forces alone will not ensure that private practices and small or rural hospitals move forward on EHRs. "There also has to be money that flows into the infrastructure, the tools and mechanisms that share data back and forth. The key thing here is that what we don't want is a computer on every doctor's desk but nothing that improves efficiency, and that comes from having the information shared."

Regional systems, or a national network?

To date, there are 66 Regional Health Information Organizations (RHIO) in the U.S., many of which are now planning EHRs and have yet to share electronic patient data. RHIOs bring together health care organizations in a defined area and control the exchange of information.

Massachusetts is one of 30 states that have introduced or passed legislation calling for the statewide adoption of standardized health IT systems. The commonwealth wants 14,000 private physicians' offices to adopt EHR systems by 2012, and its 63 hospitals, by 2014. According to Dr. Larry Garber, vice chairman of the Massachusetts eHealth Collaborative (MAeHC), putting EHRs in place will take at least two to three years and cost between $30,000 and $100,000 per healthcare provider, depending on whether it's a physician, a nurse practitioners an optometrist, etc.

With an eye toward the future, the MAeHC set up a beta RHIO in three different geographic locations. Separate from those beta RHIOs, Garber and other physicians also set up a private health network called SafeHealth, which stands for Secure Architecture for Exchanging Health Information, which was paid for in part by a $1.5 million federal grant. The distributed database for SafeHealth resides in Fallon Clinic's Worcester, Mass., data center but for now contains no patient information. Instead, it holds simple routing information that enables the movement of data from one medical facility to another.

"It takes care of concerns of someone holding onto information about you," Garber said. "The only organizations holding information about you are ones you've given permission to hold it."

Dr. JudyAnn Bigby, Secretary of Health and Human Services for Massachusetts, said it will cost about $340 million to implement a statewide EHR program. Some of that money -- about $25 million a year -- will come from higher tobacco sales taxes. But state officials also expect the private sector to chip in.

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