Electronic Health Records Spark Identifier Debate : Some say single, voluntary approach would reduce errors; others want to build on decentralized system.


WASHINGTON — One key to the widespread use of electronic health records is a single, voluntary identifier for each patient, Newt Gingrich said at a briefing sponsored by the Alliance for Health Reform. Most patients would embrace a comprehensive system based on single, voluntary individual health identifiers because of its potential to reduce medical errors and otherwise improve health care quality, said Mr. Gingrich, former speaker of the House of Representatives and founder of the Center for Health Transformation.

But Carol Diamond, M.D., managing director of the health program at the Markle Foundation, a charity dedicated to using technology to improve the nation's health care and security, called for a system that can be accessed using multiple patient identifiers.

Any new system for electronic health records should build on what already exists, she said. “We have a decentralized [health care] system. That's been the premise of our approach,” Dr. Diamond explained. “We are never going to get to this giant database in the sky that's got everything that we need.”

Last July, Markle and several health information technology organizations released a “road map” that outlines a decentralized approach emphasizing patient privacy, interoperability, and local community involvement within an established framework.

One technology solution is unlikely to fit both a two-physician practice and a hospital with hundreds of beds, said Colin Evans, director of policy and standards for the digital health group at Intel. He added that a model that's based on people accessing decentralized data “may work generally” but would require aggregation of data.

He noted that the United Kingdom's National Health Service is developing a computerized medical records system based on a semiaggregated model.

Physicians and hospitals will need both financial and nonfinancial incentives to participate in a new system, noted Mickey Tripathi, president of the Massachusetts eHealth Collaborative. “For doctors in small practices, it's risky to invest $25,000–$50,000 for an [information technology] system,” he pointed out, noting the marketplace currently provides no incentives to do so.

The organization is currently setting up pilot projects in three Massachusetts communities. The pilots will help Blue Cross Blue Shield of Massachusetts decide how to invest $50 million in a statewide electronic health infrastructure. Mr. Tripathi said the pilot projects allow local communities to determine their own needs and require minimal interoperability within their own area and a statewide grid.

Government can play an important role in “eliminating barriers to entry,” said Zoe Baird, Markle Foundation president. “We're all grappling with who will develop [interoperability] standards and what policy attributes they have to achieve,” she added.

Mr. Evans said a number of initiatives among both health and technology industry groups are “closing in” on interoperability standards for health care.

The Bush Administration has pledged to finance projects intended to spur adoption of computerized health records within the next 10 years. Last year, it appointed David J. Brailer, M.D., as the nation's first national health information technology coordinator. However, Congress in November declined to allocate $50 million Bush had requested for Dr. Brailer's office and pilot projects for fiscal year 2005. The administration has requested $125 million for fiscal year 2006, but no Congressional action is expected until fall.

In May, Rep. Tim Murphy (R-Pa.) and Rep. Patrick Kennedy (D-R.I.) introduced legislation aimed at speeding adoption of electronic health records by, among other things, waiving certain provisions of the Stark antikickback laws so that hospitals can provide information technology to physician practices, according to Rep. Murphy's staff. Sen. Bill Frist (R-Tenn.) and Sen. Hillary Rodham Clinton (D-N.Y.) are expected to introduce similar legislation.

A recently passed Kentucky law authorizes creation of a single, statewide electronic health network that will let physicians, hospitals, and insurers exchange patient information electronically. The legislation provides $350,000 as start-up money for university endowments for experts to help create the system.

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