Electronic Medical Records May Boost Patient Safety

Audie Cornish speaks with Dr. Farzad Mostashari, the national coordinator for health information technology who leads the federal government's efforts to have doctors and hospitals adopt electronic medical records. The goal is to make sure the medical practices are using those systems well, and that those IT systems talk to each other to make medicine more efficient.

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AUDIE CORNISH, HOST:

For more now, Dr. Farzad Mostashari joins me here in the studio. He's leading the Obama administration's efforts to get doctors and hospitals to adopt electronic medical records. Welcome to the program.

DR. FARZAD MOSTASHARI: Great to be here.

CORNISH: So as we just heard in that piece, you know, somebody's saying paperwork's just fine.

(LAUGHTER)

CORNISH: And in the era where we're worried about digital security and all the, you know, software bugs and all kinds of things, does he have a point?

MOSTASHARI: Paper works just fine if you want to deliver health care the way you sell shoes. If you want to wait in your office for the door to open and say, jingle, jingle, and you say, can I help you, and pull a chart and deliver care, and then when you close that chart, that information is dead, paper works just fine.

If you want to coordinate care with other providers, if you want to share information with the patient and engage them as partners in their own care, paper doesn't work just fine.

CORNISH: At the same time, this idea of sharing is still a little bit of a question, right, the capability to share? You've got so many of these electronic health record systems, and different offices are doing different things. It seems like you're getting doctors to buy into systems that actually don't talk to each other. Isn't that the point of this?

MOSTASHARI: Well, there's an important role for the federal government here in recognizing standards. It's true. We didn't say, everyone's got to use the same system, and in some ways, that, I think, would have been a big mistake. We let the providers, the hospitals choose the systems that they think works best for them, and we set standards for how those systems need to be able to talk to each other.

CORNISH: But anyone who's ever tried to send, right, a document between a PC and a Mac or something back in the day knows that interoperability is not an easy thing to deal with. It's one thing for my, you know, home documents. It's another thing for my medical care. The stakes are higher.

MOSTASHARI: It is, it is, and it's been - a lot of times the different software developers wanted to keep their proprietary standards and keep the information locked in, and I think this has been an important part of what we do and an important step up.

Medications. You've got to collect medications in a standard way so that if you exchange medication lists, the different practices can understand what they are: the immunization histories, the allergies, the problems and diagnoses. For the first time in our country's history, we now have single national standards for those health information.

CORNISH: Right now, the government is subsidizing this system as an incentive to get people into the market, and some argue that this has actually pushed out some of the smaller players, that the biggest companies who are already in the electronic health records business are the ones who are benefitting from this, which is a little bit at odds, first of all, with innovation, right, when it comes to technology? But why should taxpayers be subsidizing this?

MOSTASHARI: Well, it's a little bit also at odds with the facts on the ground, which, as you heard earlier in the piece, there's now hundreds of new entrants into this marketplace. There's actually a ton of innovation that's happening and setting standards is actually one way that helps...

CORNISH: But the biggest ones are making enormous profits right now.

MOSTASHARI: Some of them are, and some of them aren't. So it all depends on are you able to deliver a good product that people want to buy?

CORNISH: So the goals of getting everyone on to electronic health records is improving care. And is there any data right now to back that up, that it's doing that or could do that?

MOSTASHARI: There's lots of data that say that each one of these pieces is effective; electronic prescribing, ordering medications through a computer that can tell you that there's a drug-drug interaction is safer than hand-scrawling it on paper. And when we started four years ago, 93 percent of prescriptions were hand-scrawled on paper, and that is now less than half.

CORNISH: Whether you are typing something into a computer or scrawling in, you know, marginal handwriting, human error is a fact. And do you really think that electronic health records are going to make that much of a difference? I mean, it's still people doing the inputting.

MOSTASHARI: Yeah.

CORNISH: And, again, with all of the different software and different drop-down menus, I can imagine there still being errors all the same.

MOSTASHARI: Well, I think the concept here is that, you know, person plus computer is better than person alone, and that...

CORNISH: I think there's some IT people in offices around the country who are probably going to question that assumption.

MOSTASHARI: Well, the key thing is that you can't just plop in technology. You've got to really work with the people and the processes. You've got to work with the training, and you've got to look at the workflows that you're doing and not just repeat the same process - broken processes that you were doing before. So care towards implementation is absolutely critical. But the best thing we can do for patient safety is to get off paper.

CORNISH: Dr. Farzad Mostashari is the national coordinator for health information technology at the Department of Health and Human Services. Thank you so much for speaking with us.

MOSTASHARI: Thanks. I had fun.

CORNISH: On tomorrow's program, we'll profile one of the largest companies that sell these IT systems to doctors and hospitals.

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