Home' Technology Review : November December 2009 Contents Q&A
By one estimate, only 17 percent of
U.S. doctors use electronic records.
But the federal government has ambi-
tious plans to create a network in which
patient information is shared electroni-
cally among medical institutions. As
National Coördinator for Health Infor-
mation Technology, David Blumenthal is
writing the rules under which the federal
government will spend more than $21
billion in stimulus funds to get the job
done (see "Prescription: Networking," p. 34).
Blumenthal, previously a practicing phy-
sician at Massachusetts General Hospital
in Boston, spoke with David Talbot, Tech-
nology Review's chief correspondent.
TR: How long will it take to create a
national health-information network?
Blumenthal: The president has said
that everyone will have an electronic
health record by 2014. That is the goal we
are working toward right now. We are try-
ing to make the network available as fast
as we can.
Can health IT reduce the skyrocketing U.S.
The Congressional Budget O ce pro-
jected dollar savings from the [stimulus]
legislation at about $12 billion over 10
years. I expect that the actual savings will
far exceed that amount.
How do we get around the potential
problems with electronic systems---such
as overwhelming physicians with data or
actually causing medical errors?
Electronic health records and other
forms of health IT can certainly be
improved, and there are examples of bad
implementation and other problems. I
still think that on the whole, across the
country we'd be better o with universal
availability of electronic health records.
Health IT's billion-dollar man
Photograph by CHRIS CRISMAN
We'd have fewer errors, fewer missed
diagnoses, less duplication of tests, and
fewer adverse drug events.
If health-IT systems reduce such errors
and lead to fewer needless procedures,
why haven t the insurance companies
stampeded to get them installed?
The insurance companies have been
able to pass along the costs of waste in
our health-care system to their clients.
You are setting the definitions of "mean-
ingful use"---the criteria hospitals and
physicians must meet to collect their
cash incentives for installing IT. What will
be in these definitions?
I can't speak to the specific criteria at
this point. We are in the middle of writing
the regulations, and the initial release is
anticipated in December.
You re giving out $564 million for states to
form health-information exchanges
among medical providers. Why don t even
the most electronically progressive
hospitals---including your own Mass
General---already share their data?
There has never been a business case
for health-information exchange. As a
matter of fact, there has been a negative
case: if you give away your information,
you may lose it. You may lose the patient.
You mean lose him or her to a competing
The Institute of Medicine has said that
between 44,000 and 98,000 Americans
die every year from medical errors of
various kinds, and that IT can help. Are
patients dying because of a lack of
Patients are su ering because
necessary information is not available at
the point of care. With robust health-
information exchange, there can be
improved quality of care and improved
care coördination. Today, the average
65-year-old with five chronic conditions
has 14 doctors and is on multiple
Do any technological barriers, such as con-
flicting standards, stand in the way of these
hospital exchanges? Would we need to
give everyone a national health-care ID to
properly merge or reconcile their records?
No. I think we have almost all the stan-
dards we need, but we have to get people
to use them. And we can do this without a
single health-care ID.
Why not a single health-care ID? Wouldn t
that make things simpler?
We have a big job ahead of us to achieve
widespread adoption and meaningful
use of electronic records. We can get to
where we want to go without a single
Was the changeover to electronic records
difficult for you personally?
At some time over the last 10 years, I
was basically required to use electronic
records. I learned it gradually over time.
As I got more capable, I became increas-
ingly convinced of its value in clinical
care. It was making me a better physician.
How, for example?
A couple of years ago, I saw a patient
with a urinary-tract infection. I entered
the order for Bactrim [a sulfa drug] on
my computerized physician-order-entry
system---and a warning came up saying
this patient is allergic to sulfa. I am sure
in the paper record there was a record of
that, but it's often easy to overlook things
in a voluminous paper record. That kind
of gain, repeated hundreds of thousands
of times across the country, can result in
real improvements in care.
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