Copied from AARP Bulletin, - Your Health - September 2005

Interviewee – David J. Brailer, M.D. is a man with a mission. Since becoming the national coordinator for health information technology at the U.S. Department of Health and Human Services 18 months ago, he’s been urging hospitals and doctors to convert medical records to an electronic format to improve health care and even save lives.

Journalist Merrill Goosner interviewed Brailer, a physician who also has a Ph.D in economics.

Why Computerize Your Medical Records?

      Q  We live in the so-called information age, yet medical records are still kept in a file folder stored in cabinets in the doctor’s office. Why is that?
          Health care is an incredibly complicated business. It’s not just about moving money or goods around. It’s moving around a lot of variables that can have life-and-death consequences. The result is that health care businesses have taken a much more cautious approach to electronic record keeping. It has only been in the past couples of years that we’ve had enough experience to make it work. Technology is not the issue ---it is learning how to use the technology.

      Q  How could the practice of medicine be improved by electronic record keeping?
          In health care now, we have quality problems. The Institute of Medicine says that about 100,000 people die every year because of medical errors. That could be dramatically reduced, by as much as 85 percent, by switching to electronic medical records. In addition, health information technology will reduce the hassle of consumers, who won’t have to give the same information time after time. It will save money by reducing redundant procedures. People arrive at the hospital and the physician and nurses on duty have no idea what tests have been done on those patients. Finally, data will be available to patients who can choose among treatment options.

      Q  Yet the Journal of the American Medical Association earlier this year questioned whether electronic record keeping will improve health care. One article even suggested it might increase the number of medical errors. 
          This was a very good study with enlightening results. However, the study never suggested the overall number of errors would go up; it said they wouldn’t go down as much as they could because the systems wouldn’t be implemented right. Not all computer systems are created alike. That’s why we want to make sure that all electronic medical record products that are on the market are certified by private-sector experts who come together to say what [should be in the software]. We don’t want to dictate this by regulation. We want to ensure that it is market driven. 

      Q  What will that mean for average patients and their doctors?
          In the short run, physicians who use electronic health records can give better care to their patients. They are at less risk of introducing errors into their treatments. In the 
Continued: AARP Bulletin – Your Health Page 2 of 2 intermediate term, consumers will have the ability to get their own health records and get information about the best way to manage their own care.
In the long run, we’re going to see a revolution in how people access health care. People won’t have to suddenly discover they have a terrible illness. They will have access to information that will enable them to predict that they are on the verge of a major illness and take preventive measures.

      Q  Is Medicare promoting electronic record keeping?
          Medicare has begun to pay doctors for performance. All those projects have incentives built into them to put electronic health records in place. That’s a way to help doctors focus on getting better outcomes using technology. The Centers for Medicare & Medicaid Services is also developing tools to ensure that all software systems are inter-operable and the records are easily portable.

      Q  How will our privacy be protected once records are electronic? 
          We have protections for privacy in place now under the Health Insurance Portability and Accountability Act, with penalties for violations. The public needs to understand that information is better protected electronically than on paper. When records are violated electronically, we have a record of it. You have no idea if your paper records have been lifted or looked at.

      Q  A Senate committee in July passed a bipartisan bill promoting electronic record keeping. Is Congress saying the administration isn’t doing enough or doing this right? 
          That bill puts into a statute what we’re doing under the president’s executive order. It adds the confidence that Congress is supporting what we’re doing.

      Q  When will the public begin seeing electronic records in their physicians’ offices?
          Right now somewhere between 10 and 15 percent of health care consumers have personal electronic medical records. The president has given us eight years to get us up to 50 percent. That’s pretty rapid growth. That’s why we have to move quickly. 

      Q  A recent Annals of Internal Medicine article said it would cost more than $200 billion to build and operate an electronic record system. Is that correct?
          We know the numbers are in the billions of dollars. But the main question is how do we create incentives to involve the private sector so the federal government doesn’t finance it all. If you think that we will spend roughly trillions of dollars on health care over the next 10 years, $200 billion is not much, given the potential savings from reduced medical errors and from duplicative tests and procedures.

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