Health-Care Technology: Patient Involvement Helps

A new study shows the participation of patients in the use of electronic medical records can improve the effectiveness of the system

By Heather Green

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As President Barack Obama pushes for the use of more information technology in the health-care sector, a new study suggests that getting patients involved in the effort, along with hospitals and doctors' offices, can lead to substantial benefits. The research, conducted by Harvard Medical School and two other institutions, shows that reminding patients to take a critical cancer test is actually more effective than reminding their doctors about the same test. "When we talk about improving the health-care system, what we should do is also talk about how we can take advantage of our patients as a resource," says Thomas Sequist, one of the study's authors and an assistant professor of medicine and health-care policy at the Harvard Medical School, and Brigham & Women's Hospital.

The report comes just as the Barack Obama Adminstration is undertaking an ambitious effort to overhaul U.S. health care. The economic stimulus package Obama signed into law on Feb. 17 includes roughly $20 billion to help convert wide swaths of the industry to electronic health records. Experts have said for years that information technology could improve the productivity, efficiency, and safety of the health-care industry. But hospitals and doctors have resisted making technology investments, in part because they have had to bear most of the costs of technology while they reap few of the benefits.

The Obama approach aims to change the financial calculation for health-care providers. The government will give up to $65,000 to each doctor's office and $11 million to each hospital that shows meaningful use of digital records. (To be eligible, the health-care providers need to participate in Medicare, the government health-insurance program for the elderly. There are similar financial incentives for Medicaid participants.) In addition, the government will spend about $300 million to create regional data exchanges, making it easier to maintain comprehensive patient records as people switch between doctors offices, hospitals, and pharmacies.

The government will also begin penalizing health-care providers that resist the adoption of electronic records. Doctors who don't begin using the technology by 2015 will stop getting inflation adjustments for Medicare payments. The goal is to make all health-care records digital within five years. "It's a combination of a carrot and a stick," says Karen Davis, president of the Commonwealth Fund, a nonprofit research group in New York.

Stimulating Change

Both are needed, says Davis. According to the Commonwealth Fund, 25% of doctors' offices have digital records of some kind, though Harvard's Sequist estimates that only 5% have sophisticated digital records that allow their offices to operate largely without paper. Besides the cost of implementation, doctors drag their feet because of confusion about the systems and which standards to use, concerns over patients' privacy with new tech systems, and because of an unwillingness to change the way they do business.

The stimulus package may be an effective way to address those issues. The Commonwealth Fund estimates that implementing e-records in a typical doctor's office costs $40,000 in technology and lost productivity. About $2 billion of the money allotted is being set aside for the Office of the National Coordinator for Health Information Technology, or ONC. The George W. Bush Administration tapped the office to spearhead a similar push for electronic records, but the effort suffered from several shortcomings, including a shortage of funds, observers say. The ONC is now in charge of meeting a deadline for setting standards this year and having them tested and certified next year.