Electronic Medical Record Change Not Easy

President Barack Obama is making a major push for electronic medical records. But in a new study, Dr. Ashish Jha of Harvard University's School of Public Health finds 90 percent of the hospitals he surveyed have no electronic records. Jha discusses why it may be difficult to convert.

Copyright © 2009 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

ROBERT SIEGEL, host:

That's one local glimpse of the state of conversion to electronic health records, and a hopeful one. The national picture is anything by hopeful. Joanne Silberner referred to a finding that was actually published by Dr. Ashish Jha of the Harvard School of Public Health in the New England Journal of Medicine, and he's with me in the studio. Hi.

Dr. ASHISH JHA (Harvard School of Public Health): Hello.

SIEGEL: The finding was 1.5 percent of US hospitals have a comprehensive electronic records system.

Dr. JHA: Yeah. The number is not quite as dire as that, which is that another, about, eight percent of hospitals have a very basic electronic record. But no matter how you slice, 90 percent of American hospitals don't have an electronic health record.

SIEGEL: And doctors and their practices, a little bit better than that, but not much.

Dr. JHA: Not much. About 80 percent of doctors don't have an electronic health record. So we have a long way to go.

SIEGEL: President Obama is now the second president in a row to be urging a conversion to electronic medical records. So, obviously, the idea doesn't strike people in the medical profession as quite so compelling as it strikes our policymakers. Why? What don't they see in it that's advantageous?

Dr. JHA: Well, it's challenging. You know, these systems are very, very expensive. They're very disruptive to put in. And if there are financial savings to be had, if there are efficiencies to be gained, it's unlikely to go to the hospital or be felt by the doctor who puts in the system. So you're asking people to pay for electronic records and have the way they deliver care be disrupted, and yet may not - they may not reap the benefits.

SIEGEL: Does the benefit - do I as a patient get to reap the benefit?

Dr. JHA: You certainly do. So the patient certainly reaps the benefits, insurance companies can reap the benefits in terms of lower health care costs, but the doctors and hospitals, not as much.

SIEGEL: But you also acknowledge that physician resistance is a contributing factor, here. And to suggest that it's not entirely a balance sheet calculation, it's a change that people don't like.

Dr. JHA: That's right. You know, nobody likes change. And these systems are extremely disruptive. They change the way doctors practice medicine. It takes a little while to get used to. The good news is when you ask doctors a year later are you happy about the change, almost universally, they're very, very happy. They would never go back to a paper-based record.

SIEGEL: Well, let's take all those points of resistance by doctors and hospitals and offer up against them $19 billion for electronic health records that's in the economic stimulus package.

Dr. JHA: Yeah.

SIEGEL: Is that enough to win over medical hearts and minds?

Dr. JHA: It's a very good start. I think it's going to help a lot of doctors in the doctor's office getting an electronic record in. It's going to be a much smaller part of what is needed for the hospital sector. Unfortunately, it's just a down payment, and it's going to help some hospitals. But for a majority of them, they're going to need more financial aid than that.

SIEGEL: Should I be concerned about the privacy of my medical records once they're out there, digitized in various databases?

Dr. JHA: You know, that's always a concern. And the bottom line is I think both policymakers, doctors, hospitals are very aware of this issue. I think the technology exists to make sure that those records are kept confidential. I think that that is not the major barrier. I understand people's concerns, but I think at the end of the day, that's a solvable problem.

SIEGEL: Now, to be perfectly candid, on this program a couple of weeks ago, we had a failure of the digital sound editing system that crashed and it left us winging it for about an hour. Fortunately, we had no patients in surgery at that moment. I mean, should we be sanguine about the reliability of such systems in hospitals or should we say no, I'd rather have some kind of hard copy back-up for everything we do.

Dr. JHA: Yeah, that's a terrific question. And this is what makes these systems expensive, is you do need to build in those redundancies. You have to have duplicate and triplicate efforts for exactly the scenario you mentioned. I don't think that should take us away from putting in the electronic record, but we do have to thoughtful about the fact that these systems really need to be resilient.

SIEGEL: That's Dr. Ashish Jha, who is associate professor of health policy and management at Harvard School of Public Health, and the author of a study of conversion to electronic health record keeping in the New England Journal of Medicine. Dr. Jha, thank you very much.

Dr. JHA: Thank you, Robert.

Copyright © 2009 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Support comes from: