The nation’s eco­nomic stim­ulus package includes $20 bil­lion to accel­erate the use of elec­tronic med­ical records in doc­tors’ offices. Pro­po­nents say com­put­er­izing patient data has enor­mous poten­tial ben­e­fits for better health­care delivery, including quality and time­li­ness of care. We sat down with Dr. Stanley Hochberg, director of Northeastern’s health infor­matics grad­uate pro­gram to talk about what it all means in reality.

How would patients ben­efit from a uni­versal, elec­tronic health infor­ma­tion net­work?

Med­i­cine has gotten so com­plex that it is becoming dif­fi­cult for physi­cians to stay cur­rent with all the latest treat­ments and rec­om­men­da­tions. Their days are so busy that they don’t always have ade­quate time to review a patient’s com­plete past med­ical his­tory or look up the latest treat­ment. Elec­tronic health records can present the rel­e­vant parts of a patient’s his­tory and the most up-​​to-​​date treat­ment rec­om­men­da­tions right on screen while the patient is in the room. By pre­senting this infor­ma­tion clearly and con­cisely, elec­tronic health records allow doc­tors to spend more time lis­tening to and actu­ally taking care of patients, as well as sup­port them in making better treat­ment deci­sions. When a patient is referred to another physi­cian, their infor­ma­tion can be securely and effi­ciently trans­mitted between physi­cians. This does not always happen in a paper record environment.

Com­put­er­izing patient data is nothing new, so what is new about this par­tic­ular fed­eral plan?

This is the first fed­eral ini­tia­tive to commit major funding for adop­tion of elec­tronic med­ical records in indi­vidual prac­tices. Physi­cians have strug­gled to afford these expen­sive sys­tems. Funding to help with the pur­chase and main­te­nance of these sys­tems will accel­erate adop­tion sig­nif­i­cantly. The chal­lenge will be linking up these diverse sys­tems so that patient infor­ma­tion is readily acces­sible wher­ever they are receiving care.

Pres­i­dent Barack Obama explained that this $20 bil­lion invest­ment will lead to ensuring that “within five years, all of America’s med­ical records are com­put­er­ized.” Is this a real­istic time­frame?

This is an aggres­sive time frame. There is always a lag between when leg­is­la­tion is passed and when actual funds are dis­bursed. The instal­la­tion of these sys­tems can take as long as a year or more. Not all physi­cians are ready to adopt these sys­tems, even if funds are avail­able. These sys­tems require major changes in day-​​to-​​day office processes. Some physi­cians are not yet ready for that. Seven to 10 years may be a more real­istic time frame.

Most large health­care providers with 50 or more doc­tors have been using elec­tronic sys­tems to store and use patient data. But more than 70 per­cent of health­care prac­tices are small with less than a dozen doc­tors each and they simply can’t afford investing in expen­sive tech­nology. What incen­tives would make it worth­while for small prac­tices to invest in the new tool?

Finan­cial grants to cover some of the pur­chase cost for these sys­tems is very impor­tant. As prac­tices improve the quality and cost of care with these sys­tems, they should be paid more to sup­port the ongoing costs. Adding bonuses for quality to physi­cian con­tracts is a good mech­a­nism for doing this.

While the idea of com­put­er­izing health records is widely applauded, experts cau­tion about the chal­lenge of imple­men­ta­tion. Many call for cre­ating more local orga­ni­za­tions called “regional health IT exten­sion cen­ters” to help small prac­tices imple­ment the tech­nology and pro­vide tech­nical sup­port and edu­ca­tion. How do these cen­ters work and are they the answer to the imple­men­ta­tion challenge?

Unlike large orga­ni­za­tions, many physi­cian prac­tices do not have the exper­tise to select the right system, install it and sup­port it. Orga­ni­za­tions sup­ported by state and fed­eral funds can develop training pro­grams for physi­cians and their staff, and pro­vide con­sulting sup­port as go through the process of pur­chase and selec­tion. Physi­cians need an inex­pen­sive unbi­ased source for this sup­port. The for profit mar­ket­place will not pro­vide this.

Another chal­lenge being widely cited is pri­vacy pro­tec­tion. What safe­guards would be nec­es­sary to reach the goal of a uni­ver­sally imple­mented med­ical record net­work with guar­an­teed patient privacy?

There are elec­tronic stan­dards for health­care infor­ma­tion transfer already in place. Methods to verify the iden­ti­ties of both patients and physi­cians are also well devel­oped. Most sys­tems also record who has accessed a record and when, in case there is any ques­tion of a vio­la­tion of con­fi­den­tiality. Given the impor­tance of patient con­fi­den­tiality, the tech­nology to assure pri­vacy will con­tinue to improve.