This spring, Bush set the goal to have electronic health records for "most" Americans within 10 years. This would "promote cost savings and quality of health care," he said in a speech last month at the Commerce Department. He also created the position of a national health IT coordinator, whose job is to get the industry to establish an electronic infrastructure to allow sharing of digitized patient health records and other automated processes, such as electronic drug prescriptions.
Kerry also supports using IT to improve health care. His goal is for "every" American to have an electronic health record within four years. "Universal electronic medical records will dramatically reduce waste in medical care through a reduction of redundant and unnecessary tests," the Kerry campaign says in an E-mail. "In addition to cost controls, computerized medical records and decision-support software can also reduce serious medical errors by as much as 88%."
Federal mandates may be the only way, Mark Zielazinski, CIO of El Camino Hospital, says.
It's not about politics, nor is it about technology, says Dr. Carol Diamond, chairwoman of Connecting for Health, a public-private collaboration of 90 health-care organizations. "It's about reducing errors, improving patient safety, and giving patients access to their health-care information," she says.
It's doubtful every American will have an electronic health record in four years, says Linda Reino, CIO of Universal Health, an operator of several for-profit hospitals and health-care facilities. "It might happen in 10 years," she says. But the industry moves much too slowly and faces fundamental cultural and workflow problems.
Past government mandates requiring IT-related processes haven't succeeded in speeding up adoption. Most notably, the electronic transactions, privacy, and security regulations of the Health Insurance Portability and Accountability Act took years to develop, and timetables for implementation have had to be rolled back because of slow adoption rates.
The industry dislikes mandates. But they may be the only sure way of getting widespread adoption, especially of technology standards for sharing digitized health records, Zielazinski says. "Unfortunately, this industry won't do anything without a mandate," he says.
Whoever is elected also will appoint a new head of the Food and Drug Administration, since the position is held by an acting commissioner. Former FDA commissioner Mark McClellan, who now heads the Centers for Medicare and Medicaid, showed how FDA requirements can drive IT initiatives. He backed rules, set to go into effect in two years, for bar codes on single-dose packaged medicines administered in hospitals and other care settings. Bedside bar-code systems let nurses and other caregivers scan drugs before they're given to patients, double-checking drug information against patients' records and doctors' orders so that dosage or other mistakes can be caught before patients receive drugs.
Zielazinski says he hopes that whoever is appointed FDA commissioner will be "bold enough to give the bar-code rules more teeth," closing loopholes that some drugmakers use to avoid adding bar codes to products that aren't packaged in single doses. Says Zielazinski, "It needs to be much clearer to hospitals that they need to use these bar-code systems."
Illustrations by Hanoch Piven
"Offshoring" and "Broadband"