US medics may be paid to use electronic patient records

The US Secretary of Health and Human Services (HHS), Tommy Thompson, has published a 10-year plan that plans to introduce electronic health records (EHRs) and a network to link them across the country; but clinicians may be paid in order to encourage them to adopt the new technology.

The paper, entitled "The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care", comes in response to an executive order from President Bush that called for "widespread adoption of interoperable EHRs within 10 years".

However, research has shown that there is little appetite within the US healthcare community for adopting electronic records, and that "a large gap remains between the promise of EHRs and the capacity and willingness of clinicians to use them." Only 13% of US hospitals were using any form of electronic records in the most recent survey in 2002, and the report says that many are prevented from implementing them due to "insufficient resources or a negative return on investment associated with purchase, implementation and operation."

One thing, therefore, that David Brailer, MD, the new National Coordinator for Health Information Technology, is exploring to counter this problem is paying clinicians to use EHRs.

The Centres for Medicare and Medicaid Services (CMS), which administer Medicare to 40 million Americans on behalf of the US Government, may pay health professionals for each individual use of EHR through adding special claim codes. Alternatively, the system could operate on an electronic 'pay-for-performance' basis that demands adoption of EHR in order to process clinicians' claims.

The US Department of Defence will also be heavily involved with implementation of EHRs, due to their "significant experience in delivering care in isolated conditions… which can be compared to the conditions in some rural healthcare environments". They are expected to share expertise with the private sector in telehealth for radiology, laboratory results retrieval and online education.

The paper highlights the "fragmented and volume-based model of health-care financing in the US" that "rewards physicians and hospitals for transactions, rather than for patient healthcare status and quality", and says that there is a need for a national health information network that is "inexpensive and secure". The most probable way this will be implemented is through a public-private partnership. Private enterprise will be heavily involved in the implementation, though "minimal product standards" will be set by the federal government. The health information network and EHRs are expected to use SNOMED Clinical Terms and HL7.

The goals that the HHS hope to achieve by implementing EHRs are to interconnect clinicians, inform them of the benefits of electronic records, personalise care so it becomes "consumer-centric" and help individuals "manage their own wellness" and improve the general health of the population.

Despite the projected difficulties, the HHS is confident that health IT can be overhauled "without substantial regulation or industry upheaval". An initial $50m (£30m) will be invested this year in research and development.

The report is publically available from the HHS website, and can be downloaded here. (PDF, 10.4MB)