The healthcare bill's take on technology

As Senate Democrats negotiate to move the healthcare reform bill to a final vote in the chamber, I checked in with a health and technology expert to talk about about one aspect of the bill that hasn't received much attention: health IT.

Denise Anthony is research director for Dartmouth College's Institute for Security, Technology and Society, as well as a faculty affiliate for the Dartmouth Institute for Health Policy and Clinical Practice.

"I was really pretty impressed with the bill," she told me this morning. "It recognizes the role of information technology in facilitating better coordination of care and better access to primary care and research...but it's not suggesting that technology is the silver bullet that is going to fix healthcare."

Ever since President Obama's stimulus package set aside nearly $20 billion for health IT projects--namely electronic medical records--there's been a lot of talk about how IT will help doctors work more efficiently and give patients access to their health histories. The 2,000-page healthcare bill includes the word "technology" 26 times, and often calls for details to be addressed by the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services. (Committees in that office are currently coming up with security and privacy standards for these systems.)

The current bill also appoints an assistant secretary for health information technology and devotes resources for community-based telehealth resource centers.

"Getting the systems in place is necessary but not sufficient to improve the quality of care," she said. "Certainly we have to have these good IT systems in place for practitioners to share information in a more efficient way. But simply putting the money toward putting them in place isn't enough."

New forms of errors are introduced with new systems. For example, electronic medical records are often hailed as a way to let primary doctors and specialists communicate with each other. But some researchers are finding that doctors are simply "cutting and pasting" information into health records that isn't necessarily specific to the patient and isn't as individualized as it should be.

"So there's actually less information being conveyed--the ironic unintended consequence of electronic health records," she said.

Another potential problem: If patients gain access to their health records and can see what doctors are writing about their conditions, doctors may start to censor their comments.

"Does that mean the specialist can no longer communicate as frankly with the primary care doctor?"

Doctors are most concerned that the systems will actually add extra work to their days, even after spending millions of dollars to install new technology and convert their paper records to digital ones. And hospitals will all need to have interoperable systems so a doctor in one town can talk with a nurse in another.

In the same way consumers can buy different components of a computer or a stereo system from different companies, physicians also need to buy parts that suit their needs. But they all have to work together when they're plugged in--the same way consumers can plug any telephone into a phone jack and make calls.

"That's the ideal," she said. "The question is, can we get there, and how long will it take?"