Obama's national health records system will be costly, daunting

But an electronic health records system could save the nation $300B a year

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Asif Ahmad, CIO for Duke University Health System in Durham, N.C., said he was able to roll out an EHR system, called HealthView Patient Portal, that was built on an open-standards and services-oriented architecture for $6 million -- far below the pricy estimates offered by Brailer and others. The five-year project, now in its second year, already gives students access to a wealth of personal health information.

Duke finds a way to be frugal

Duke was able to keep its existing software and hardware systems and employed IBM's WebSphere Java-based software tools to create an online medical record site accessible by patients, who can then share the information with whomever they choose. In the first eight weeks it was up and running, more than 2,500 patients registered in healthview.dukehealth.org.

"Duke's HealthView portal is like your online banking or Expedia account, which pulls information from various sources and displays it to you. You can also pay your bills online, schedule appointments online," Ahmad said. The portal relies on a series of redundant Web servers to ensure uptime.

Soon, patients will be able to view clinical test results, renew prescriptions, change insurance information and get proxy access to their children's records. They will also be able to fill out medical forms online, review medical procedures or watch medical treatment videos.

"It took us three months to do it," Ahmad said. "That's it. You use the information by putting it into a common relational architecture. What we don't want in the country right now is hospitals getting into a [technology] replacement cycle."

Given that all hospitals have IT systems already in place, he suggested they use existing systems and applications and pull patient information into a data warehouse that can be shared with physicians and patients. "Just fill in the gaps and only buy the applications you need," he said.

"That's the beauty of this. ... We organized the information in a vendor-agnostic fashion," Ahmad said. "We're also looking at disease management. Someone who has diabetes or hypertension -- to be able to manage that online so they don't come into emergency rooms like train wrecks -- [it allows] more focus on prevention and education through the portal."

Duke is also currently speaking with Google and Microsoft to be able to share information beyond its campus with any hospital or private physician that is also a member of Google Health or Microsoft's HealthVault.

Regardless of whether the Obama plan leads to private or public online health record services, Brailer said records and systems will need to be regulated to ensure data security under the Health Insurance Portability and Accountability Act (HIPAA), which protects Americans' health information.

"Ironically, HIPAA creates felony penalties if a doctor or hospital abuses the data, but there's absolutely no penalties for a Microsoft or a Google because they're not covered by the law," Brailer said. "It's nothing that they're doing wrong. It just shows you the state of mind of Congress when that rule was written 10 years ago, because they never ever envisioned there would be online services managing health information.

"I think that's a very high priority, because one consequence of the President-elect ramping up people's attention to this is that people will come back to a lot of their fundamental worries about the protection of their health information," Brailer said.

Copyright © 2009 IDG Communications, Inc.

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