Inside e-health: Digital Health Records? ‘Yes We Can’

The US’ new president, Barack Obama, has made investment in electronic medical records and health IT a major plank of his public works programme to lift the US economy out of recession. It could also galvanise healthcare systems around the world, says Jon Hoeksma.

The inauguration of President Obama has been heralded as the dawn of a new era in US politics.  But on one thing at least, the new president is at one with his predecessor: the goal of providing electronic medical records to all Americans within five years.

Where President Obama differs from President George W Bush is in the resources he is ready to commit to this daunting policy objective. President Bush saw the role of the government as setting policy and standards, removing legal barriers and funding pilots.  President Obama believes far more must be done.  

From campaign pledge to Presidential mandate

A commitment to invest in electronic medical records featured in Barack Obama’s campaign pledges. Last week, House Democrats unveiled plans to spend $20 billion on them as part of President Obama’s American Recovery and Reinvestment Plan.

National accreditation and standards efforts will continue to play a central role in federal plans; but to make them stick, billions of dollars will be made available to help healthcare providers shoulder the cost of investment in IT.  Much of the money will be targeted at the publically-funded Medicare and Medicaid providers. Others will need to invest in standards that meet core standards and are able to interoperate.

The proposed investment is part of a much wider, $825 billion programme of public works that ranges from weatherproofing houses to refurbishing schools, investing in roads, power lines and IT networks. The idea is to take up the slack in the US economy and lay the foundations for future growth. 

Providing all Americans with electronic health records will need the kind of leadership and commitment that saw New Deal projects like the Hoover Dam built, the Manhattan Project completed, or a man on the moon by the end of the 1960s.

Electronic health records, and the digitisation of healthcare they signify, do not easily inspire politicians or voters in the way these projects did; but they offer far-reaching future benefits to the economy and society. Specifically, they should help to modernise the ailing US healthcare system; the largest component of the US economy.

Invest to save

There is huge variety within the vast US healthcare system, but recent estimates suggest that only about 8% of the country's 5,000 hospitals and 17% of its 800,000 physicians are using full electronic medical records. Recent estimates from the RAND Corporation and Commonwealth Fund suggest the cost of fully digitising US medical records could be as much as $100 billion. 

So although it sounds like a lot of money - even against the backdrop of bank bail outs that are running into the 100s of billions of dollars - a $20 billion investment is still only pump priming. The healthcare industry is expected to shoulder most of the necessary investment costs.

Given the size of the $2 trillion a year US healthcare system, $20 billion would still represent just 0.1% of annual healthcare expenditure. Yet the need for pump priming is highlighted in a new survey by the American Hospitals Association, which found that many hospitals are responding to the deepening US recession by cutting back on investment in facilities and IT projects. 

Meanwhile, that $100 billion is a lot of money by any measure. Yet many experts believe the benefits that should be delivered in terms of in improved efficiency, improved safety and better quality of care have the potential to dwarf the initial costs. 

David Brailer, the former National Coordinator for Health Information Technology, who worked under President Bush from 2004 to 2006, said he expected computerised health records to save the industry $200 billion to $300 billion a year once they were in place. This would equate to improving the efficiency of US healthcare by about 1% a year.

World leader

However, as anyone involved in the industry knows, big healthcare digitisation projects that appear compelling at the business planning stage often prove fiendishly difficult to implement successfully.  In Europe, England, France, Austria and Germany have all encountered significant problems in successfully delivering national health IT projects.  

Having said that, health IT needs more big successes. If the US can successfully mobilise a concerted programme to computerise health records, it would strengthen and provide new momentum to efforts across the globe.  Strong and concerted leadership may prove be just as important as the money.