Just a day after being sworn into his new job as Director of the Centers for Medicare and Medicaid Services, recess appointee Dr. Donald Berwick has his official coming out this morning in the grand hall of the Department of Health and Human Services.
Is this where the stethoscope goes?
The occasion was the unveiling of new rules that will determine which electronic medical records systems will be eligible for a slice of the $27 billion in federal money provided by the 2009 stimulus bill.
Doctor and hospital groups were pleased that the final version of the rules makes it easier for them to qualify for the funding without hitting targets they found unrealistic in the real world. Those included things like reducing the percentage of doctor orders and prescriptions that need to be entered electronically in the early years of the transition from paper record-keeping.
But for some of the bureacrats, the love of electronic records is personal. Berwick, formerly a practicing pediatrician at the Harvard Community Health Plan, practically waxed rhapsodic when talking about how his former HMO was an early pioneer in the transition from paper to computer.
"I never had to go hunting for a missing piece of paper with a lab test written on it that I needed," he said. "All the results were there, right there, as soon as the lab that produced the result." And if he sent a child to see a specialist, ther was "no phone tag after that, wondering what happened. The specialist notes were there for me, and the family, just as soon as the specialist prepared those notes."
With electronic medical records, Berwick said, "It's smoother care. It's better, it's more reliable."
Berwick got a huge ovation from the crowd of mostly health industry and consumer reps who packed HHS -- glad to see him finally installed at CMS despite a furious campaign against his nomination by Senate Republicans. But it was actually U.S. Surgeon General Regina Benjamin who stole the show.
Benjamin told a story -- a version of which is published online by the New England Journal of Medicine -- about how she finally came to begin using electronic medical records, but only after her primary care clinic in Bayou La Batre, Alabama, was destroyed three times in seven years.
After Hurricane George destroyed the clinic in 1998, Benjamin said, she had to choose between paying the light bill and putting in electronic medical records. "The light bill won," she said.
After Hurricane Katrina washed the clinic away again in 2005, her staff, once again, found itself drying patient files in the hot Alabama sun.
Then, the day before the clinic was set to re-open around New Year's 2006, it burned to the ground, this time taking all the files with it. "I'd previously decided against installing an electronic health record because I couldn't afford one," she said, "I realized now I couldn't afford not to have one."
And one thing Benjamin, unlike many doctors, didn't have to worry about was getting her staff to buy in for the the training to use a new electronic system. That was no problem, she said. "My staff told me they didn't want to have to bake charts in the sun again."