Health Care Reform We Can All Agree On

Since I run my own small business, I'm very interested in health care reform. You see, my tiny -- two-person -- company pays more than four figures a month for health insurance. Ow!

That and taxes are the two biggest expenses on my ledger. Unfortunately, I don't see much reason for hope in the crippled mess that has made it this far in Congress. Still, no matter what ends up passing into law, one common theme in all the reforms is support for electronic health records, and that's good news.

EHR is just what it sounds like: maintaining medical records in an electronic format. Some of my records are on papers locked in cabinets. God help me if someone needs to know what my EKGs from a few years back looked like.

I'm not alone. According to an April 2009 survey in the New England Journal of Medicine, only 1.5% of U.S. hospitals have comprehensive electronic records systems, and only 8% have basic systems that cover at least one clinical unit. Think about that: Almost every important financial transaction you do is recorded online, but your medical records are stuck in the 19th century.

Earlier this year, Congress did manage to pass a program called HITECH (Health Information Technology for Economic and Clinical Health) as part of the stimulus package. It earmarked $19 billion for Medicare and Medicaid technology incentives over the next five years and included support for EHR implementations.

Of course, there are problems with EHR. Some people are paranoid about what could happen if their medical records were available online. I can't argue with them. I'm sure bad things will happen. On the other hand, if I had to go to the emergency room at the second-closest hospital to my home, the doctors there wouldn't know any more about my medical history than a doctor in Somalia.

Imagine: You're in really bad shape, and they want to know not only your name, but also your health insurance number, your Social Security number, whether you've ever had a heart attack, and more. All things considered, I'd like to have a standardized EHR system.

Of course, I just used that troublesome word standardized. Today, EHR systems tend to be a mishmash of incompatible systems that use incompatible formats. You think you have trouble reading Word 2007 files with Word for Mac or Office 2003? Try reading an EHR with a program that didn't create it. You can't do it.

Even if all of your doctors are using the same system, you're still not out of the woods. Burton Group senior analyst Joe Bugajski says he almost died because "incoherent database design isolates patient information from one department to the next and from one organization to the next." He found that even doctors and nurses who tried to use the system spent more of their time fighting it than getting any use out of it.

Wonderful.

Clearly, EHR by itself is not a panacea. There is one system, VistA -- the public-domain EHR system developed by the U.S. Department of Veterans Affairs -- that's relatively widely used. In addition, there's an open-source version, WorldVistA, that should help forestall record incompatibility problems. That's the theory, anyway. In practice, there are several versions of VistA, such as Medsphere Systems' OpenVistA. The compatibility problems aren't as bad between VistA versions as they would be between VistA and non-VistA EHRs, but they're still there.

Nonetheless, I live in hope. Any EHR is sure to be better than paper health records. Now, if everyone would just agree on standardizing at least the data formats and rationalize the database management system designs, we might finally get somewhere with health care reform. Hey, I can dream can't I?

Steven J. Vaughan-Nichols has been writing about technology and the business of technology since CP/M-80 was cutting-edge and 300bit/sec. was a fast Internet connection -- and we liked it! He can be reached at sjvn@vna1.com.

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