State helping to shape US efforts to digitize health records for all
Almost 50 years ago, a Harvard-educated president gave voice to a lofty ambition: to send men to the moon before the end of the 1960s. A collection of brainiacs at MIT and Raytheon designed and built the electronic navigation system that safely guided six Apollo spacecraft to the lunar surface.
Earlier this year, another Harvard-educated president laid down another big challenge: By 2014, every American will have an electronic medical record, with the goal of cutting the cost - and improving the quality - of healthcare.
While having your healthcare history digitized may not be as inspirational as seeing Neil Armstrong step off that ladder, it’s likely to affect your life much more directly over the next decade.
On the job this time is a posse of Massachusetts-based doctors, professors, entrepreneurs, and information technology experts from local hospitals and insurers, armed with $20 billion of stimulus money. And local companies like Westborough-based eClinicalWorks Inc. and athenahealth Inc. of Watertown, which sell software and services to maintain electronic records, will be likely beneficiaries of that spending.
“Massachusetts is like the Silicon Valley of healthcare information technology,’’ says Paul Egerman, who began writing medical records software in the early 1970s, after he took a job at Massachusetts General Hospital.
Egerman went on to start one company, IDX Systems Corp., that was bought by General Electric for $1.2 billion, and another, eScription Inc., that was acquired by Nuance Communications Inc. last year for $363 million. He is now a volunteer adviser to David Blumenthal, the national coordinator for health information technology - and a former Harvard professor and Mass. General physician.
How did people and companies from Massachusetts become so influential in the roll-out of electronic medical records, or EMRs?
First, we’ve had more experience with them than just about any other state. Westwood-based Medical Information Technology Inc. has been writing software for hospitals since the year of the first moon landing. Massachusetts doctors and hospitals do more electronic prescribing - eliminating the need for handwritten scraps of paper - than their counterparts in any other state.
According to John Halamka, chief information officer at CareGroup Healthcare System, “The average use of EMRs in the US is between 2 and 20 percent. In Massachusetts, we’re somewhere between 30 and 50 percent, so we’ve had a fair degree of experience with what works and what doesn’t work.’’ Halamka is cochair of a committee that will help Blumenthal determine a sort of Good Housekeeping Seal of Approval for electronic medical records - essentially, what features do they need in order to be government-certified.
Second, Massachusetts won influence because Harvard economist David Cutler was the primary architect of candidate Barack Obama’s healthcare plan. “Cutler sort of dreamed up the idea of spending $50 billion or so on healthcare IT as part of Obama’s platform, when Obama wasn’t likely to win,’’ says David Williams, a consultant at MedPharma Partners in Boston. “That number became the basis for the dollars in the stimulus bill.’’
The opportunity in creating electronic medical records for all is huge. Imagine going to an emergency room while on vacation and granting the doctors there immediate access to your whole medical history (perhaps preventing them from spending thousands of dollars to duplicate tests you’ve already had). Of course, keeping these new records secure will pose a challenge, but medical errors and conflicting prescriptions would be reduced. And for the system as a whole, another big advantage is being able to look at how healthcare is practiced nationally - and determine whether there are more efficient (and possibly cheaper) ways to treat diabetes, for instance.
Right now, Blumenthal’s office is working to define two things: what will constitute a “certified’’ EMR and how will doctors and hospitals prove to the government they are using EMRs in a “meaningful’’ way. Starting in 2011, doctors and hospitals that deploy EMRs will be rewarded by more money from Medicare reimbursements - and eventually, those that don’t use them will be penalized with smaller reimbursements. (All that money comes from the stimulus funding - which some predict could far surpass $20 billion over time.)
This Thursday, Egerman, the volunteer adviser on health information technology, plans to be at a public meeting in Washington to explain the proposed certification standards and solicit comments from interested parties. The goal, he says, is for Washington to send a clear signal by the end of 2009 about how EMRs will work so that a widespread roll-out begins in 2010.
Companies that sell services and software for EMRs have had to figure out how to generate revenues without the stimulus - though they agree it can’t hurt their business. EClinicalWorks software is already used by about 25,000 doctors, and the company brought in $100 million in revenue last year. The company is hiring about twice as quickly - roughly 200 people in 2009, mainly in areas like training and customer support - as it would be without the stimulus, according to Girish Navani, eClinicalWorks chief executive. The company also announced a surprising deal earlier this year to distribute its software to doctors in part through Sam’s Club, the discount retailer. A package of the software and Dell computers to run it starts at $25,000.
“All of a sudden, doctors are talking about EMRs, and Barack Obama is giving them, essentially, a 20 percent-off sale price for the next four years,’’ says Jonathan Bush, chief executive of athenahealth. Athenahealth’s business today mainly involves helping doctors manage their billing and other back-office functions, but about 1,000 physician practices are using the publicly traded company’s EMR offering.
One concern about the deployment of EMRs is that the incentives might not prove appealing enough to most doctors, since they’ll still have to pay the up-front costs of the technology, and spend time learning it. And some worry that entering data into a patient’s record - rather than just writing on a paper chart - will slow them down.
Even if the Massachusetts brain trust can help Obama reach his goal of an EMR for every American, it may not have that much of a short-term impact on the country’s overall healthcare spending.
“There are modest cost reductions to be had through administrative simplification,’’ says Halamka, the CareGroup chief information officer, “like doing less redundant testing.’’ The real savings, he predicts, will come from the much bigger project of healthcare reform - for instance, paying doctors based on the quality of care they deliver, rather than simply on quantity.
“We’re laying a foundation for healthcare reform,’’ Halamka says. “Without information about what’s being done, you can’t really look in-depth at the question of quality.’’
In that way, it’s not too different from NASA’s voyages to the moon: the benefits have played out over decades, from satellite navigation systems to solar panels to implantable cardiac defibrillators.
“The big picture,’’ says Navani, “is truly transforming healthcare, rather than just spending a lot of money and not getting to our goal.’’
Scott Kirsner can be reached at kirsner@globe.com. 