“These ivory-tower types try to boil down the art and practice of medicine into something that can’t be boiled down,” said Bernstein.
Practical barriers
About 20 percent of U.S. hospitals and and 30 percent of office-based primary-care doctors — about 46,000 practitioners — had adopted a basic electronic record in 2010, according to government statistics. But most doctors would need to upgrade those systems to qualify for federal incentives. Recent surveys show that more than 45,000 doctors and hospitals have sought information or registration assistance from the federally funded help centers set up around the country to give free hands-on support; an additional 21,000 have begun signing up for the payments.
Advocates say the benefits of computerized systems are numerous. When a doctor or nurse is about to decide on a prescription or lab test or whether to hospitalize a patient, “there is nothing as powerful as giving them information that is relevant to them just at that point,” said David Blumenthal, the government’s national coordinator for health information technology. In addition to gathering each patient’s medical history in a single database, the systems use reminders and alerts that register allergies and unsafe interactions when a new drug is prescribed. They also allow doctors to check for previous labs and X-rays to prevent duplicative tests.
Blumenthal, who recently announced his return to his Harvard University teaching position, said he benefited from such an alert when he ordered a CT scan of a patient’s kidney. An electronic reminder told him a previous CT scan had imaged the patient’s kidney. He canceled the order.
“If every doctor had that kind of experience once a month, think of all the money and incovenience to the patients that could be saved,” he said.
Critics worry about privacy concerns and medical errors. Doctors seeking cash incentives for going digital must use systems capable of being encrypted. But no federal regulations clearly require that doctors turn the data encryption on or prevent those who don’t do so from getting paid, said Deven McGraw, director of the health privacy project at the Center for Democracy & Technology, an advocacy group.
“This is a point of frustration,” said McGraw, who sits on an advisory group that sought unsuccessfully to prevent those who violate privacy regulations of the federal Health Insurance Portability and Accountability Act, or HIPAA, from getting incentive money.
Joseph Kuchler, a spokesman for the Centers for Medicare and Medicaid Services, acknowledged that providers can operate an electronic system with its encryption turned off. But any that do so are violating HIPAA and face stiff penalties, he said. (As a condition of receiving payments, providers are also required, generally, to protect health information privacy.)
Those potential penalties “will serve as strong incentives to ensure that the encryption technology is not permanently turned off,” Kuchler said.
As a practical matter, doctors say, they keep encryption functions turned on to comply with HIPAA patient privacy rules.
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