Barriers to Greater Use of Health IT Remain
WASHINGTON — Although e-health activities are becoming commonplace, a variety of legal, financial, and logistical issues still must be addressed for the technology to realize its potential for physicians and patients, the American College of Physicians said in a position paper.
The challenges for effectively implementing e-health activities lie not only in the adoption of universal technical standards for the exchange of electronic health information, but also in the more fundamental concern of economic support for health information technology, the ACP said in a new position paper, which was released at the group's annual meeting and posted at www.acponline.org
“ACP believes that patient portals and personal health records may provide the biggest benefits to patients when they are used collaboratively with physicians,” said ACP President David Dale at a press briefing at the meeting. But Dr. Dale added that “the biggest single concern of physicians is the substantial cost in acquiring and maintaining the necessary technology, which averages $50,000 per physician.”
The paper, “E-Health and Its Impact on Medical Practice,” analyzes the benefits, technical and financial challenges, and legal issues related to adopting and implementing e-health activities for physicians and patients.
These issues include the privacy of medical records, financing and payment for physicians adopting electronic records and communication systems, computer literacy among patients, and telemedicine development and funding. The ACP also recommends the creation of national standards for e-health Web site content.
Dr. Joel Levine, chairman of the ACP Board of Regents, said at the briefing that e-health initiatives have great potential to transform health care in the United States, especially as part of the development of the patient-centered medical home. “ACP recommends ongoing investment in demonstration projects … within the context of the patient-centered medical home,” Dr. Levine said.
However, Dr. Dale and Dr. Levine both said that payment policy reforms are needed to compensate physicians appropriately for their investment in and implementation of e-health services. The new fee structures likely would include some sort of flat fee that would cover all communications with a patient, they said.
“This is the management of chronic health we're talking about—you can't do that by giving me 25 cents every time I click on my Blackberry,” Dr. Levine said.
In addition, confidentiality, privacy, and standardization are needed to create a trusted nationwide health information network, according to the ACP, as health care providers and individuals are likely to be reluctant to adopt e-health activities unless they are confident that the systems are secure and accurate.
In the paper, the ACP calls on technology developers and policy makers to support standards that address interoperability, functionality, security, privacy, content, and legal liability. In addition, it recommends the use of secure Web messaging infrastructure rather than standard e-mail to ensure the highest levels of confidentiality for electronic communications between physicians and patients. Records of communication fall within the parameters of the Health Insurance Portability and Accountability Act and therefore must be protected according to HIPAA standards, the ACP said.
