The push for digital medical records, fueled by $19 billion from the federal stimulus package, would completely change the way doctors prescribe and practice medicine—by digitizing the entire medical record-keeping process.  Backers say such technology will cut costs and save lives.  But a growing body of research suggests potential challenges

According to The Portland Business Journal, more than 50 percent of the state’s doctors currently use electronic medical records. That’s more than double the national average, meaning the state could receive a disproportionate share of the $19 billion in federal stimulus money allocated to the digital technology switch.

Providence Portland Medical Center was recently recognized as being the best in Oregon and in the top one percent in the country for Electronic Medical Records (EMR) adoption by HIMSS Analytics, an organization that maintains data on the use of electronic medical records at hospitals and health systems across the U.S.

The EMR Adoption Model score enables health systems and hospitals to compare their adoption of EMR tools, the higher the stage, the greater the adoption. According to the Providence Health & Services website, Providence Portland is the only hospital in Oregon to reach HIMSS Analytics EMR adoption stage six.

“This recognizes that the hospital has deployed proven approaches for increased patient safety and improved quality, including computerized provider order entry, bar-coded medication verification, electronic physician documentation, and is working to eliminate paper-based processes across the institution. A paperless patient record means that critical patient information can be accessed by all care providers from the physician’s office to Emergency and by specialist physicians,” according to the website.

In addition to Providence Health System, Legacy Health System, Kaiser Permanente, and Oregon Health & Science University have at least started the switch to digital records.

Although the federal government set a goal five years ago of creating a digital health record for everyone by 2014, the effort has lagged for several reasons, including concerns over the lack of universal procedures for collecting data as well as the lack of rules that establish how, with whom and under what circumstances the data can be shared.. Many healthcare providers fear liability if private information is leaked to unauthorized sources. Another major roadblock is cost, an estimated $150 billion, which has proved to be a significant obstacle to that 2014 target.

To encourage the switch to digital records, under the current federal stimulus program, physicians and their practices are eligible to receive $44,000 to $64,000 in incentives, and hospitals as much as $11 million, for technology purchases over the next five years.  In theory, these incentives should encourage the flourishing of technology that will computerize physician orders, automate the dispensing of drugs, and digitally store patient medical records.

According to the Obama Administration, these changes will improve health care, eliminate errors, and eventually save billions of dollars a year.  But there are also penalties.  Providers who treat Medicare and Medicaid patients and have not gone to paperless systems within five years could lose reimbursement funding.

However, few expect the new incentives and penalties to change things immediately.

According to BusinessWeek, although studies have shown that some large networks, such as the Veterans Administration and the Kaiser Permanente system, have used electronic records to help cut costs and improve care, so far there’s been little proof that digitalizing medical records will result in significant savings or improve patient care.

According to a study published in the New England Journal of Medicine, the high cost and uncertain quality of technology products currently on the market are major reasons why only 1 in 50 hospitals has a comprehensive electronic records system and why only 17 percent of physicians use any type of electronic records.

Another hindrance to the switch is the belief among hospital officials that, once installed, mass-produced technology systems will require costly and time-consuming customization.  That customization will in turn make it difficult for other hospitals and health care providers to share data, which is a key goal of the initiative.

Another significant roadblock is the lack of a centralized source for reporting technology failure issues from one medical provider to another.  Although the federal government collects and disseminates this kind of information on drugs and medical devices, technology contracts customarily ban medical providers from disclosing any systemic defects.
According to BusinessWeek, Obama Administration officials insist they are proceeding with caution and will learn from and correct any mistakes that are identified along the way. But some question whether any issues raised by doctors and researchers will be taken seriously, stemming from a perceived conflict of interest as a result of the strong ties forged between health technology companies and President Obama, his top medical advisers, and key Republicans,.

The U.S. Food & Drug Administration is currently considering whether to regulate health technology in the same way it currently oversees medication and implants. However, according to BusinessWeek, technology companies are lobbying the Administration to keep product testing and standards under the sole authority of the Certification Commission for Healthcare Information Technology, which is a non-profit entity, pointing out that any additional red tape at this point would hinder the adoption of useful technology.

However, widespread technology spending and adoption is unlikely to occur until universal standards are set for the secure collection and handling of medical information.