This past year’s health discussion has been remarkable for the narrow range of ideas and opinions that have floated down to the man on the street. Journalists have sought out the same organizations and sources for their stories, offering up what has become the conventional wisdom for reform. To bring more voices into the conversation, our series, Excluded Voices, will intermittently feature health care experts who aren’t on the media’s A-list of sources. (The entire series is archived here.) We want to offer journalists more options for their stories and encourage a deeper conversation. To that end, we’ve asked the experts featured in each post to respond to questions from Campaign Desk readers.
In President Obama’s reformed health care world, information technology is the magic potion. It will reduce the cost of health care—which, in turn, will mean cheaper insurance premiums, allowing all Americans to have health coverage at some time in the future. Skeptics believe otherwise. Given the prominence of health IT in the administration’s line-up of health reform goals, it’s surprising how little coverage the media has given the topic. Last week there were signs of change. In his New York Times column, David Brooks took on IT and other cost control measures, noting that most experts don’t believe that these measures will “produce much in the way of cost savings over the next 10 years.” And a Washington Post story by Robert O’Harrow, Jr. examined how the IT industry stands to profit handsomely from the Obama initiative.
There’s a lot to report, so Campaign Desk talked to Jonathan Oberlander, a health policy expert and professor of social medicine and health policy & management at the University of North Carolina—Chapel Hill, to help journalists report the health IT story.
Trudy Lieberman: What do we mean by health IT?
Jonathan Oberlander: It generally refers to the use of computers in providing medical care. Electronic medical records—moving your paper health records into an electronic format—is a prime example.
TL: Are there differences in what is meant by an electronic medical record?
JO: Some electronic records just have descriptive information like diagnoses and what medications you’re taking. Others go beyond this and let doctors order prescriptions and lab tests electronically. Some can generate patient reminds for screening services and offer guidelines that help doctors diagnose and alert them to contraindications for drugs they’ve prescribed.
TL: When did interest in these systems take hold?
JO: It gained momentum in this decade. But in the last four years, it really picked up steam.
TL: To what extent are electronic medical records being used now?
JO: The New England Journal of Medicine has reported that about 17 percent of the doctors and 10 percent of hospitals are using them. And that means the basic kind of record, not the comprehensive variety.
TL: Why so few?
JO: Primarily the cost, which can be prohibitive for hospitals and small groups of doctors. Both are worried that it’s an investment that might not pay off. Systems can also be costly and difficult to maintain.
TL: How much does it cost to buy these systems?
JO: The Congressional Budget Office said that, in 2008, the cost for office-based record systems was between $25,000 and $45,000, but there are systems that are more expensive. For hospitals, we’re talking in the millions of dollars.
TL: Why are electronic records superior to paper ones?
JO: They are thought to be superior because they cut down on medical errors and allows doctors to do a better job. They allow doctors to manage care because they can track a patient’s progress, and they may also reduce the need for redundant, unnecessary tests that happen because paper records cannot be located. Electronic medical records can also generate data that help us identify what works and what doesn’t work in medicine.
TL: How will the stimulus package help move providers to adopt these records?
JO: It does it the old-fashioned way—by throwing money at the problem. If doctors and hospitals that participate in Medicare and Medicaid adopt “meaningful” information technology, they are eligible for bonus payments.
TL: What is meant by “meaningful”?
JO: We don’t know. The National Coordinator for Health Information Technology, David Blumenthal, will make that decision.
TL: How much will these payments be?
JO: Payments won’t start until 2011 and will range from about $40,000 to $65,000 for doctors. For hospitals, we’re talking about millions of dollars.
TL: What is the projected penetration of electronic medical records after the stimulus money takes effect?
JO: The Congressional Budget Office believes that we can reach 90 percent in a relatively short period. By 2019, we can get up to 90 percent for doctors and around 70 percent for hospitals.
TL: Who really benefits from all this money?