The Security Catalyst

By Patrick Romero

In 2004, President Bush set a goal that by 2014 most Americans would be using an Electronic Medical Record (EMR). In his vision, doctors would be using EMR systems with interoperable standards that would allow them to share lab results, images, computerized orders and prescription information with hospitals and other health facilities.

The Office of the National Coordinator for Health Information Technology was created by President Bush to guide the work on EMR standards and coordinate public and private efforts. Its job is to define minimally functional systems as those on which doctors can record and manage progress notes, order tests, record test results and electronically prescribe medications.

The reasons for the insufficient progress are many, according to the report, “Gauging the Progress of the National Health Information Technology Initiative.” They include slow adoption of EMRs by physician practices, the impractical nature of a national health information network, the difficulty of creating interoperability standards and Congress’ failure to pass legislation addressing health IT roadblocks.

A 2005 survey estimated that only 13 percent of solo practitioners and 16 percent of groups with 2–4 physicians have adopted EMRs, compared to 29 percent of groups with 10–19 physicians and 39 percent of groups with 20 or more physicians. The office, created by Bush to guide the work on EMR standards and coordinate public and private efforts, defines minimally functional systems as those on which doctors can record and manage progress notes, order tests, record test results and electronically prescribe medications.

Slightly more than a quarter of practices with 11 or more physicians — a situation that describes only 8% of doctors — used comprehensive EMRs in 2006, according to an October 2007 Centers for Disease Control and Prevention report based the National Ambulatory Medical Care Survey. Solo or single partner practices — which account for almost half of all doctors — reported much lower levels of comprehensive EMR use: 7.1% of solo practitioners, 9.7% of those with a partner.

Another reason for slow progress on EMR adoption is that a national health information network is impractical, said experts in the California foundation report. The system is intended to be a “network of networks” linking state, regional and other health information exchanges so they can share information.

According to the eHealth Initiative Foundation (eHI), 28 states have initiated Health Information Technology (HIT) planning and an additional seven states have progressed to the implementation stage.

Privacy Concerns

The Medicare Electronic Medication and Safety Protection Act (S 2408), sponsored by Sen. John Kerry, would require physicians to use e-prescribing for Medicare patients or face a 10% cut in payments. The bill is pending in the Senate Finance Committee.

Deborah Peel, head of the Coalition for Patient Privacy, said an e-prescribing bill would be an excellent opportunity to prohibit data mining.

Privacy advocates are concerned that the bill should come with more privacy protection. They would like to require that any prescription data transmitted electronically be used for the express purpose of prescription filling and submitting the necessary codes to the insurer for payment. Other provisions being sought are annual reports to patients listing everyone who accessed their data and mandated security breach notifications.

While EMRs are not a panacea to fixing our national medical system, they do offer more than traditional modes of storing information. The government should continue to encourage doctors toimplement EMRs in their practice through substantial grants and subsidization. There are currently such programs but more needs to be done to publicize them. While a mandate might eventually be necessary, there are less restrictive alternatives currently available. Nevertheless, it is time that the medical community catch up with other sectors of our economy that have embraced the use of digital information.

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