Photo by Jonathan Kannair
David Blumenthal, MD, the national coordinator for health information technology, has spent a lot of his career thinking about health policy. He’s on leave from Harvard Medical School, where he’s a professor of medicine and health policy.
Now, with health-care reform settled, the next big hurdle in the health arena for the Obama administration is implementing electronic health records, commonly known as EHRs.
There’s a lot of debate about what exactly EHRs will achieve. Proponents say they will usher in a new era of patient-centeredness and shared decision-making between patient and physician. They’re touted as delivering better disease management and improving care for people with chronic disorders. And then there’s the financial savings, estimated to be between $33 billion and $77 billion over 10 years. Critics think that the financial savings and dreams of delivering better health care are illusory at best. They contend that EHRs will give the consumer less efficiency, greater costs and inconsistent quality of care.
So medical school executive communications director Paul Costello took those questions to the top and asked Blumenthal: What about the critics? What are physicians saying about EHRs? And what’s it like taking on such a huge task while under a political microscope? Are careers in public service worth the public scrutiny?
“It’s obviously a challenge to build a new program of this size with this ambition,” says Blumenthal. “But it’s also exciting. Public service is a valuable career for young people — one that I hope more and more young people will consider, both young physicians and other people interested in health.”
Costello: Why is health care behind so many businesses in using technology to improve service and efficiency?
Blumenthal: There are a lot of reasons. One is that the incentives are not lined up to reward performance. People get paid just as well for delivering care that is inefficient or unsafe as they do for care that is efficient and safe. The money doesn’t drop to the bottom line the way it does in a business setting. Another important reason is that electronic health records are complicated. Health care is complicated. It’s a team sport, where information is critical — and that information is often fragmented and diverse and needs to be brought together from many sources at the same time in order to develop a good treatment plan.
Costello: Why should patients care whether their physician uses electronic health records? What do you tell them?
Blumenthal: Well, I tell them that they’re going to get better care. And I can illustrate it with stories from my own experience as a clinician using an electronic health system, where it’s prevented me from giving medications that my patients were allergic to, prevented me from doing tests that were duplicative, given me access to information that makes it possible to answer patients’ questions at the time they want the information, given me vital information when I’m on call for other physicians, and given me the information I need to make better decisions about their care in emergency situations. I think most patients get it. I mean, I don’t think you have to convince patients that this is valuable. Some are worried about whether the value will come along with threats to their privacy. But the value, I think, is readily apparent to most patients.
Costello: Yet some are worried. Last year 59 percent of respondents in a Kaiser/Harvard survey said they’re not confident that electronic health records will remain confidential. How is the federal government addressing this?
Blumenthal: We’ve adopted standards for the privacy and security of electronic health records, against which they can be certified. So that’s a first step. And one of the proposed certification criteria is that all providers actually test the security of their electronic health systems. We’ll continue to work on the standards and certification criteria over the coming years, because we’re just at the beginning of this process.
Costello: The Bush administration set 2014 as the year electronic health records would be available for Americans. Is that still the timetable?
Blumenthal: We want to accomplish as much as we can, as soon as we can. We believe we will make a huge amount of progress over the next three to four years — under the influence of incentives we’re offering, but also because I think the congressional action and the administration’s work have made it clear to professionals and to hospital managers that this transition is inevitable. It’s part of being up to date. It’s part of being at the top of your game. It’s part of being capable as providers of care. So, we are going to make, I think, a great deal of progress. I think it’s achievable.
Costello: I wonder if you’d talk a minute about the need for a skilled work force that understands the use of health-information technology.
Blumenthal: We need people who can help doctors become meaningful users. We’re not talking about installing records. We’re talking about helping physicians take advantage of records, get the benefits of them. And that’s where I think our biggest gap is. And the same is true for nurses and for other health professionals. So, that’s why we’re funding the training of such a work force under our legislation. I expect that if meaningful use takes hold, and if value-based payment takes hold, there will be a private-sector market for that kind of a trained work force.
Costello: Clearly, with sophisticated health technology, there will be a lot more health data to evaluate. This will undoubtedly ramp up comparative-effectiveness research. But, as we saw not long ago with the outrage over draft federal guidelines reducing screening for breast cancer, there’s a huge gap between gut reactions and what the hard data actually suggest. Do you envision a lot more struggles like this?
Blumenthal: I think as we get better evidence, we’ll get better care. There may be periods of controversy as we digest that evidence. I think that’s healthy. A vigorous public debate is the way we spread information in this country.
Costello: When you travel around the United States, what are physicians telling you? What’s on their minds?
Blumenthal: Physicians want to take the best care they can of their patients. They want to be the best they can be. They feel that there are a number of obstacles they have to overcome to do that. They have a perverse payment system with the wrong incentives. They have an enormous number of conflicting requirements, from private insurance companies, from employers, from the government. I think what they want is simplification, a reduction in hassles, a reduction in administrative burdens, a reduction in the complexity of the payment system and support in caring for patients in meaningful ways. We think that the electronic health record can give them many of those benefits.
Interview condensed and edited by Rosanne Spector