LIANE HANSEN, Host:
Doctor Jonathan Oberlander is among those who say the president's plan will not significantly cut health care costs. Dr. Oberlander is an associate professor of social medicine and health policy at the University of North Carolina at Chapel Hill. He's currently a visiting fellow at the Russell Sage Foundation in New York and he's in our New York bureau. Welcome, Dr. Oberlander.
JONATHAN OBERLANDER: Thanks for having me.
HANSEN: And among those who support the president's plan is Dr. John Halamka, who is the chief information officer at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, and he joins us from Harvard. Welcome to the show, Dr. Halamka.
JOHN HALAMKA: Thank you very much.
HANSEN: Let's start with you, Dr. Halamka - and Dr. Oberlander, I'd like you to comment on the same thing. An article published Thursday in the New England Journal of Medicine reported that there are a number of obstacles to a cost- effective electronic records database, like incompatible software systems, the enormous costs of installing hardware, training staff and so on. I'd like to get your perspective on that study. And I'll start with you, Dr. Halamka. What do you think?
HALAMKA: Sure. Our experience in Massachusetts is there are ways to do this right, which reduces the cost of implementation. So we've come together as a community and built data centers with Web-based electronic records that physicians can use from their offices without a lot of hardware or software investment. Now, there does need to be a fair amount of training. And we certainly have to have what we consider best practices, like electronic prescribing and exchange of laboratories, in order to get really the full bang for the buck from electronic health records. But at least working together in a region, we have been able to achieve that lower cost and significant cost savings with improved quality and safety.
HANSEN: Dr. Oberlander?
OBERLANDER: Well, I think what the study underscores is how far we have to go to meet the president's goal in health information technology. Really, the United States lags other rich democracies. And what that study shows is actually a very small percentage of our hospitals have adopted meaningful electronic medical records.
HANSEN: But you are opposed to the president's plan. What is it about the plan that you object to?
OBERLANDER: I'm not opposed to the president's plan. I'm opposed to exaggerated expectations surrounding the president's plan. And I think maybe the most important point is this - the American medical system is a mess and we are not going to compute our way out of that mess.
HANSEN: And Dr. Halamka, how would you answer Dr. Oberlander then?
HALAMKA: Oh, I think we would agree that you need to change process. You need to change payment. Health care reform is very, very important in addition to electronic systems.
HANSEN: Now, how would this be done? Dr. Halamka, you have said that this electronic record system is in use in Boston. That might be fine for Boston, but is it something, do you think, that can be implemented nationwide?
HALAMKA: So the plan, as outlined in the American Recovery and Reinvestment Act, creates 40 to 60 communities and groups that come together like we have in Massachusetts, to help doctors implement these systems. We don't want to put servers in doctors' offices. Doctors are great scientists and clinicians, but they're not IT professionals, by and large.
HANSEN: And Dr. Oberlander, what are the drawbacks to that? Particularly, let's talk about electronic prescribing, because one of the effects that's been mentioned is that it could be possible that a patient might get the wrong medicine.
OBERLANDER: You know, what they're really doing is pumping money into the system. They're pumping money in the system to try and speed up the adoption of electronic medical records. And I think on balance that's a good goal. The problem is it's not clear that adopting electronic medical records on a nationwide basis is either going to dramatically improve quality or certainly not control costs.
HANSEN: Dr. Jonathan Oberlander is a professor of health politics and policy at the University of North Carolina at Chapel Hill. He's currently a visiting fellow at the Russell Sage Foundation in New York. He joined us from our New York bureau. Dr. John Halamka is the chief information officer at Harvard Medical School and Beth Israel Deaconess Medical Center. He joined us from Boston. Thank you both.
OBERLANDER: Thank you.
HALAMKA: Thanks very much.
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