Besides the cost, another potential stumbling block for Bush's goal of a national system is that widespread interoperability isn't a top priority even among hospitals embracing electronic medical records.
Kaiser's electronic-records system will connect its 12,000 physicians by 2006. But interoperability with other companies' systems will be a priority, initially at least, only in areas where Kaiser has insurance patients but doesn't own hospitals, such as Colorado.
Camino Medical Group, a multispecialty group of 200 doctors, spent less than $1 million in 1997 to create a Web portal for accessing electronic data from multiple sources, says CIO Mahnaz Choobineh. The portal gives physicians access to data such as that in lab, pharmacy, and radiology systems. Camino is experimenting with new voice-recognition technology that will let doctors automatically add dictated notes to electronic records, but it has no plans to connect to other health providers' medical systems.
Infrastructures will be built within the next 10 years for regional medical information, CareGroup's Halamka says.
Photo by Sacha Lecca
Privacy is another potential obstacle. "The public will wonder, how much access does the government have to my medical information?" says Jeff Hall, director of information services at St. Francis Health Center in Topeka, Kan. "The technology is there, but the bigger questions are ethical."
Bush's marching orders for the health-technology coordinator include addressing privacy. Many in the industry contend that privacy protection will be a benefit of electronic records. "Electronic safeguards for medical records are actually much more secure than old-fashioned paper records, which sit around on desks and on shelves, frankly, unsecured," Kaiser's Liang says. "You have no way of knowing who looked at [a paper] record."
Most health-care leaders don't think electronic records will become an outright government mandate. And many say Bush's 10-year goal is realistic--and so is Kerry's more-aggressive target. The Healthcare Information and Management Systems Society predicts electronic records will be standard practice by 2010. Says Janet Marchibroda, CEO of eHealth Initiative, a nonprofit organization, "The stars and planets are aligned."
-- with Thomas Claburn