One of the ongoing scandals of the current U.S. health care system is its relative isolation from the information technology revolution that has transformed so many other industries, from financial institutions to travel and hospitality. With some exceptions, most health care providers still keep records, order prescriptions, and make medical decisions based on fragmented paper documents; and most Americans have no real-time access to or control over these documents. This isn’t just a matter of convenience: the current health information system contributes significantly to life-threatening medical errors, unnecessary tests and procedures, and delays in treatment, lowering health care quality and boosting costs. Indeed, just yesterday Sen. Hillary Clinton identified health information technology as one of the keys to any effort to rein in skyrocketing health care costs, reinforcing her long record of leadership on this issue.
As a new report by David Kendall of the Progressive Policy Institute shows, the IT revolution can and must be quickly adopted by our health care system.
Current progress in that direction is slow and insufficient, Kendall explains. Amid widespread calls for a new health information network, the Bush administration has called for a 10-year effort to voluntarily encourage physicians to keep patient medical records electronically. But even if that “works,” it won’t create any real system where records can be shared securely among providers and insurers, with patients controlling access. There exists a potentially enormous market for independent health record “trusts” that can manage health information, but only if a framework is established to ensure patient privacy and interoperability of data. As experiments in Seattle, Spokane, Kansas City, and Indianapolis have shown, electronic health records systems are practicable right now. And aside from the improvements in health quality that would spur, the savings would be enormous: as much as $500 billion over 15 years, according to a RAND study.
As far and away the largest purchaser of health services, the federal government has the unique opportunity and responsibility to jump-start this system by taking three specific steps:
1. Set federal rules for independent health record trusts. These standards should include privacy and security protections for patients, and interoperable IT standards for health care providers to transmit patient information back and forth with health record trusts. In addition, the government should create a certification process that bestows a regulatory seal of approval upon trusts that are verifiably adhering to these government standards, much as federal regulators provide for financial institutions. Trusts will be responsible for working collaboratively to develop protocols for the private, confidential, and secure storage and transmission of patients’ health records among all the players in the health care system. Reps. Dennis Moore (D-Kan.) and Paul Ryan (R-Wis.) and Sen. Sam Brownback (R-Kan.) have proposed legislation to promote such organizations.
2. Give patients a legal right of access to medical records that are already being stored electronically. Current federal law only gives patients a right to a paper copy of their records. Congress should require doctors, hospitals, health plans, and other entities with electronic patient data to give a patient’s health record trust access to that patient’s information so it can be gathered together in an Electronic Health Records account. The Moore-Brownback legislation and another bill by Reps. Patrick Kennedy (D-R.I.) and Dave Reichert (R-Wash.) would give patients this legal right. In addition, Sen. Tom Carper (D-Del.) and Rep. Jon Porter (R-Nev.) have proposed legislation to require health plans in the Federal Employers Health Benefits program to give federal employees access to records stored in the computers of the health plans.
3. Strengthen patients’ privacy rights. Regardless of where or in what form health records are stored, federal law should give patients the right to control who has access to them, review a list of people who see them, and be notified of any security breaches. These Electronic Health Records accounts would give providers an inexpensive and easy way to protect patients’ privacy and to follow their privacy preferences.
These three steps would almost immediately facilitate the creation of a robust, competitive system of health records trusts all operating under the same rules, collecting and storing information that can be readily exchanged and compared, under the firm direction of patients themselves. Every physician would soon be able to pull up on a computer screen a comprehensive patient profile including health conditions over time, treatments, prescriptions, and tests. And every American would have the assurance that medical decisions are being made on the basis of up-to-date and reliable information.
Source: ndol.org
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