From folders to networks

Spread among folders at the offices of maybe a half-dozen doctors and possibly hospitals, the traditional paper medical record is not necessarily efficient, secure, or accurate. Employees certainly and visitors sometimes have access to the folder-lined walls where many physicians keep their patient data. Charts may be misfiled, pages can fall out, and a spilled latte can wipe out years of data.

In recognition of the problems, medical institutions over the years have turned to computerization to manage patient information. At first these systems weren’t connected. But gradually, large health-care providers, including the Department of Defense, the Department of Veterans Affairs, and managed-care companies, each linked individual office computers to form integrated systems that would allow health-care workers to retrieve patients’ test results, including blood work, radiology, and biopsy reports.

After 9/11, federal officials recognized that a national system of interconnected records could help them spot early evidence of biochemical attacks and epidemics. “It takes 26 days for our current fragmented system to process data at the local level, then the state level, and have it rise to the level of concern to reach the Centers for Disease Control and be properly analyzed,” Brailer says. “In a fully integrated national system, problems can be spotted in a day.”

To have all records connected to a nationwide system, providers, insurers, pharmacies, and other health-care entities will have to pay some $150 billion over the next five years. “It can cost up to $35,000 per doctor to get a fully integrated system in place,” says Peter Waegemann, CEO of the Medical Records Institute (MRI), a group that has promoted the establishment of electronic health records. And, according to Brailer, some of the costs will eventually be passed on to consumers.

MRI’s database contains 2,500 software and hardware suppliers. Some of them sell systems that support large provider chains. Others peddle specialty programs, such as ones tailored to dentists. “The problem is that most of these systems are not compatible, so they can’t communicate,” Waegemann says. “We need standards to be implemented or else the whole system could collapse.”