Electronic Records Are Key to Health-Care Reform

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William A. Yasnoff, M.D., PhD, is an Arlington (Va.)-based physician and computer scientist. He is currently managing partner of National Health Information Infrastructure (NHII) Advisors, a health information technology consulting firm.

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Health-Care Cost Savings

Of course, successful health record bank operation depends on all medical records being electronic. Today, however, fewer than 20% of physicians use electronic medical record systems in their offices, primarily because most of the financial benefits of these systems accrue to others. Financial incentives for electronic medical record systems from health record banks could promote universal adoption and solve this problem, thereby achieving the President-elect's goal.

The Obama Administration's strategy for achieving universal electronic medical records should include policies that facilitate and encourage health record bank development including: (1) statutory privacy protection of medical information; (2) requiring physicians to supply a no-cost electronic copy of newly generated medical information at the time of service (which could be directed to a health record bank account); and (3) making health record bank account fees (up to $12 per year) a covered benefit for all federal health beneficiaries (federal employees, Medicare, Medicaid, Defense Dept., Veterans Administration, Indian Health Service, etc.).

This latter policy would only create expenditures when a health record bank account is actually opened and used—and having the account would ensure health-care savings of at least 10 times the covered cost. Taking these actions to develop a system of health record banks represents an inexpensive yet critical first step in health-care reform that could simultaneously save money, save lives, and protect individual privacy.

As I commented on the story, "Wal-Mart Launches E-Health Program," HIPAA's privacy rule actually allows disclosure of private medical information without consent to anyone for "treatment, payment, or health-care operations" (TPO), thereby eliminating privacy. While this HIPAA provision at first appears to be quite reasonable, the decision about whether a specific disclosure is for TPO is made solely by the entity that holds the information with no notice to the patient, no possibility for review or appeal, and no requirement for keeping records of the disclosures. The current system is anticonsumer—and certainly not in the spirit of President-elect Obama's goals to improve the U.S. health-care system.

William A. Yasnoff, M.D., PhD, is an Arlington (Va.)-based physician and computer scientist. He is currently managing partner of National Health Information Infrastructure (NHII) Advisors, a health information technology consulting firm. He previously served as senior advisor, NHII, U.S. Health & Human Services Dept. from 2002-2004.