Health Care


The stimulus package before the House includes $20 billion to help computerize medical documents. During his campaign, President Obama promised large and sustained spending for health information technology. NPR's Joanne Silberner investigates whether this spending is likely to create jobs, or to cut the nation's health care bill.

JOANNE SILBERNER: Right now, only 17 percent of doctors have computerized practices. Increasing that will create jobs. Just ask Dr. John Halamka. He's the chief information officer at Harvard Medical School at one of its teaching hospitals, and he oversees 20,000 computers dedicated to health care.

Dr. JOHN D. HALAMKA (Chief Information Officer, Harvard Medical School): It requires a lot of hands-on. This means you need training and education, much more than hardware and software. And that means a lot of people.

SILBERNER: Halamka has helped more than a thousand doctors in Massachusetts go electronic. They can use to computers to order tests and drugs. They have access to patient records anywhere they have a computer. And the computers can prompt them about possible diagnoses and treatments. Halamka has used the Massachusetts experience to calculate what it would take on a national level to train health personnel and get systems up and running.

Dr. HALAMKA: It comes out to about 50,000 new jobs just directly involved in electronic health record roll out.

SILBERNER: Then there are hardware jobs, software jobs and a growing number of Internet companies that let people keep their own records online.

Dr. HALAMKA: All told, it probably will be about 200,000 new jobs with the House stimulus package.

SILBERNER: That's not far from an estimate used by the Obama administration. Even opponents of the House bill say it will create jobs. Their main complaint is that the jobs won't come soon enough. There would be a two-year phase-in period. Supporters of health information technology say there's a second benefit. Dr. Paul Tang is the chief medical information officer at the Palo Alto Medical Foundation.

Dr. PAUL TANG (Chief Medical Information Officer, Palo Alto Medical Foundation): The longer-term payoff for this investment is to have the majority, if not all American physicians, using electronic health systems and producing better care. And better care, I believe, will result in lower costs. So that becomes self-sustaining.

SILBERNER: Tang and others say doctors who can look up your record on a computer won't need to send you for a second MRI if they don't have the results of your first one. The computer won't let them automatically prescribe a drug that will cause you problems. Halamka at Harvard has some numbers.

Dr. HALAMKA: Fifteen percent of our health care is redundant, while we spend $30 billion a year, just in Massachusetts. So 4.5 billion in just Massachusetts of dollars that would be saved through coordination of care.

SILBERNER: There is some argument among economists about how much the health care system as a whole would save through computerization. What can be said now is this. The federal government would pay more, not less. The Congressional Budget Office estimates that with the House bill as written, the overall impact to the budget would be $17 billion in total costs by 2019. Some politicians and planners are concerned about pushing programs of this size through Congress so fast. James Gelfand of the U.S. Chamber of Commerce also says a number of provisions need a more careful look, including how to make sure that patient records are kept private while still making them available to healthcare personnel.

Mr. JAMES GELFAND (U.S. Chamber of Commerce): We've been trying to find an answer to that for two Congresses now. It's been, you know, more than four years we've been debating this issue, and we haven't reached a consensus. So how are we going to pass a bill now, when there is no consensus that's been reached?

SILBERNER: Lawmakers will have to reach that consensus quickly if they want health IT in the stimulus bill. The House is expected to pass its version today. The Senate could vote on its version soon. The self-imposed deadline for working out the differences between the two bills is mid-February. Joanne Silberner, NPR News, Washington.

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