'Going digital' going slowly

For two decades, electronic health records have been the Next Big Thing in health care: a way to simultaneously improve care and reduce waste in a system clogged with paper and manila folders. In 1994, President Bill Clinton announced that all doctors would use computerized records within 10 years. In his 2004 State of the Union, President Bush called for universal use of digital health records.

The result of all these grand declarations: 90 percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records.

"Health care is at least a generation behind the rest of society in terms of technology," says David Merritt, director of the Center for Health Transformation, a think tank based in Washington. "Doctors and hospitals don't use the technology we take for granted everywhere else."

The reasons for this lag are many: a colossal, inertia-filled health care system, a paucity of good software, no incentives to adopt new technology and a lack of government leadership. There is also concern, which advocates of digitization say is overstated, about the security and privacy of records containing the most intimate of personal details.

But almost everyone agrees that moving from paper to bits will improve health care. Numerous studies and reports, including one last month from the Maryland Health Care Commission, have found that electronic health records can reduce medical errors, save lives and save perhaps hundreds of billions of dollars if all doctors and hospitals went digital and were networked together.

Electronic health records also speed up service. After the emergency room at Beth Israel Deaconess Hospital in Boston went completely digital, the average length of stay dropped by 45 minutes.

"You can get any information, on any patient, when you want it," says John Halamka, an ER doctor there, as well as the hospital's chief information officer who oversees the e-records of 3 million patients. "There's no more 'I can't find this patient's chart.'"

But the transformation hasn't spread far, at least in the U.S. In Denmark, 90 percent of the health system is computerized. Germany completed its health care digitization two years ago.

"Pretty much every country in the developed world is doing better than we are," says David Lansky, director of the health program at the Markle Foundation, a nonprofit technology think tank in New York.

Of course, unlike every other developed country, the U.S. does not have nationalized or otherwise closely coordinated health care. The U.S. system is also much larger and more unwieldy than any other: a $2 trillion industry, staffed by 700,000 doctors, most of them essentially small, independent business people who are generally paid not by their customers, but by insurance companies.

"It's such a convoluted system," Merritt says. "When you think about changing that kind of behemoth, it's daunting."

Even so, he and other experts say, the federal government could do much more to encourage doctors and hospitals to leave paper behind.

"It's hard to believe that America lags behind the world in adoption of the information technology that can save lives and make health care more affordable - yet that's exactly the case today," Massachusetts Sen. Edward M. Kennedy, who has been pushing the issue for years, said through a spokesman. "Congress and the administration should make a commitment to bringing the nation's health system into the information age."

One key is incentives. For an individual doctor or a small practice, switching from paper to digital costs between $40,000 and $60,000. For most doctors, this is a lot of money: The average physician pulls in about $150,000 a year. And the savings from going digital mostly accrue to the insurance companies, Merritt said.

"There's no incentive to adopt the technology," Merritt says. "No one helps them offset these costs."

The government says it has picked up the pace. "We've made good progress over the past couple of years," says Department of Health and Human Services official Herb Kuhn, who is heavily involved in health information technology.

Last year, the federal agency began a program that offered to cover 85 percent of hospitals' cost for going digital. And last week, the department rolled out a pilot program that will pay most of the costs for 1,200 small practices to install electronic records. That program is budgeted to spend up to $150 million over the next five years.

If that sounds like a lot, it isn't, many experts say. Lansky points out that the few thousand doctors affected by the program are a tiny percentage of the total. He says the government should do much more.

"These are small businesses," he says. "To ask individual businesses to spend $40,000 on a technology that doesn't make them money is not fair."

Some major institutions have decided on their own to modernize, partly because going digital on a large scale can save millions. The Department of Veterans Affairs, which for decades had a reputation as a backwater of bad care, has transformed itself. It is now fully electronic and networked.

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