What would you say to the next president of the United States about healthcare information technology?
C. Peter Waegemann, the chief executive officer of the Medical Records Institute, put the question to hundreds of attendees in the audience of the opening day, plenary session of the Towards an Electronic Patient Record trade show Monday afternoon in Fort Lauderdale, Fla.
Waegemann said he thought some of the candidates, based on their announced healthcare IT promotion plans, could use some friendly help and advice. Hillary Rodham Clinton, he said, has quoted a 2006 RAND Corp. report that estimated the nation would save $77 billion a year if the country made adequate investment in healthcare IT, while Barack Obama has promised to spend $50 billion over a three-year period on IT.
"Maybe I don't know enough about electronic medical records or I'm naive, but I don't see it," Waegemann said, tongue firmly planted in cheek. Waegemann's Boston-based institute has hosted TEPR for 24 years. Germany, he said, has spent the equivalent of several billion dollars on what he called "an outdated smart card system," adding that "no government has really been successful" in providing IT subsidies.
"I personally believe this will be in the next two or three years—the major push for healthcare IT will come from the consumer," he said. "I believe no amount of funding will do the same as what is going on" in the private sector.
Here is a sampling of some other bits of presidential counseling from audience members:
"At the end of the day, we all have documents that can be electronically stored," one attendee said. "If we put all of our medical records on a JumpDrive—Adobe files, Excel files, Word files, DICOM images"—it would save a lot of effort wasted on interoperability schemes if those common formats are used. What the government should do is focus on developing common standards to read and write those files, he said. "That's what I'd tell the president."
"We need to do something to reduce medical liability for doctors," a woman said.
"I think that we have leveraged the Internet in almost every industry we deal with except healthcare," another speaker added. "The industry must absolutely move forward and embrace the Internet."
One woman was chagrined by what she described as the ignorance of our political leaders about healthcare IT and the lack of understanding of the providers' perspective. "The president is educated by what he is being told by lobbyists," she said. "The legislators are being told what they are being told by lobbyists." And after recently meeting with Sen. Clinton, with all of her vaunted experience in healthcare policy, the would-be TEPR presidential adviser said she was similarly unimpressed with Clinton's grasp of IT. "She has no idea what money comes out of it except what she gets through reading. Hillary has no idea what an EMR is. I think that's where you need to start is with the education of these people who spend millions of dollars and have no idea where it goes to."
Another audience adviser recommended giving a large boost in the budget of the Agency for Healthcare Research and Quality to develop and integrate evidence-based practice guidelines in healthcare IT systems.
But one commenter said the fault is not in our investments, or in a majority of allegedly technophobic physicians who have been yet to buy and use electronic health-record systems, but rather in the systems themselves, which have not become so easy to use that they become invisible to the user.
"I don't agree with the statement that physicians are recalcitrant," he said. "I think that physicians are the first to use technology when it improves patient care. Look at MRI. That was embraced within a matter of days."
"The truth is," he said, "the technology should disappear. It should adapt itself for the 80-year-old or the 60-year-old (physician). I think we are giving ourselves excuses if we don't invent technology that disappears. If technology gets in the way of that, I think we need to be cognizant of the fact that maybe what we have invented isn't perfect yet and we need to keep inventing."
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