How do you heal the ills of American health care? You might start with its circulatory system: health records.
In February 2009, more than a year before health care reform kicked off with the passage of the Affordable Care Act, Congress included the Health Information Technology for Economic and Clinical Health, or HITECH, Act in an economic stimulus package, setting in motion a nationwide migration to electronic health records.
The act diagnosed the illness: American health care could no longer afford the inefficiencies and opacity of paper record-keeping. And, it prescribed a cure: Wean doctors and hospitals from handwritten charts and prescriptions by 2015.
The electronic records initiative fits seamlessly with a central cost-saving tenet of health care reform: to shift U.S. health care from an expensive, pay-per-service system based on quantity to one that emphasizes quality. The goal now is to have medical payments reward good care -- in a way that's difficult to do with paper records.
"You really can't have accountable care without electronic records," says Judy Hanover, a research director for IDC Health Insights, a health care research and marketing firm based in Framingham, Mass. "It provides the data and information foundation you need to implement accountable care."
'This is going to rock!'
Why should you care about how your doctor keeps records? Because, thanks to the technological push, you'll soon have online access to your complete medical records for the first time.
The government says not only can electronic health records reduce unnecessary tests and procedures, help your doctor coordinate your care with other providers and avert medical mistakes due to incomplete or incorrect information, but they also may save your life by enabling you to carry all of your own health records on your cellphone or mobile device. Medicare and Veterans Affairs beneficiaries already can access their claims records through the federal "Blue Button" online service.
"This is going to rock!" says Dr. Farzad Mostashari, the national coordinator for health information technology and the captain of the federal electronic records initiative. "This is going to change things in a pretty fundamental way."
Getting America's health care providers to go digital has been no easy task. Mostashari notes that there are hundreds of medical software vendors of all sizes and more than 1,000 software systems in use, and few of them communicate with one another. Some physicians continue to view electronic note-taking as time-wasting rather than time-saving.
To ease the pain of transition, Congress allocated $27 billion for financial incentives, including Medicare and Medicaid bonuses to be doled out to hospitals and physicians able to demonstrate "meaningful use" of digital records and meet program milestones.
Health care's new DNA
Many doctors and hospitals adapted easily to the project's first phase, which has involved capturing and sharing data and prescribing medications electronically. Beginning as early as 2014, providers who hope to reap their full financial incentive bonus from the feds will have to interact with one another electronically in measurably meaningful ways and provide patients with secure online access to their health records. Physicians and hospitals that don't show progress will see their federal reimbursement rates cut beginning in 2015, until they join their peers in the 21st century.
Providers also face the challenge of making their electronic health records systems work well with those of health insurance companies. Robert Zirkelbach, a spokesman for America's Health Insurance Plans, an industry trade group, says insurers are frustrated with what they perceive as physician foot-dragging.
"It's vital to build both sides of this bridge," he says. "Health plans face significant penalties under the Affordable Care Act if they don't allow for providers to be able to send information electronically, but there isn't the same requirement on providers. If providers are still using clipboards to fill out information and faxing bills to health plans, we're not going to get there."
Mostashari insists such growing pains are part of weaving what he calls the three strands of the new health care DNA. Strand one: Pay for value, not volume. Strand two: Use digital tools to deliver better care. Strand three: Involve patients in their own care.
More engagement from patients
It's the third strand that most excites Mostashari.
"It's been said that the patient is the most underutilized resource in health care. If we want to get better health and lower costs, guess what? There's someone who really wants to help us: the patient, their caregivers, their parents, their siblings," he says. "We're going to be open to the possibility that we may learn something by letting the patient help."
Hanover, of IDC Health Insights, says that despite the sometimes erratic progress on the technological front, health care reform and electronic health records will succeed in tandem, if for no other reason than they must.
"It's the only way health care can be sustainable," she says. "We know that our current level of health care spending -- about $2.7 trillion a year, or 18 percent of gross domestic product -- is just not sustainable, and it's predicted to grow as the aging of the population continues."
Hanover calls electronic health records "the one idea that has come forward that really has the potential to both make people healthier and help reduce costs in the long run."
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