The Knoxville News Sentinel had a bold headline on the front page of today's local section proclaiming "Electronic exchange of patient info close" with the sub heading "AT&T and Tenn. create system for accessing, sharing medical records." The opening paragraphs state:
AT&T Inc. is partnering with Tennessee to provide the country's first statewide system to electronically exchange patient medical information, the telecommunications company will announce today.
The system is designed to securely transmit detailed patient information between medical professionals.
It will allow doctors to access medical histories, prescribe medicines over the Internet and transfer images like X-rays, MRIs and CT scans.
The problem is that the system is not a medical records system and it does not manage patient histories or medical imaging as one might conclude from reading the article.
Instead, if you read closely it says that the system allows "exchange" and "access" and is designed to "securely transmit" information. That's all it does, as far as I can tell. But what do you expect from a cut and paste wire report rewrite of an AT&T press release?
It's like the cable guy coming in to your home or office and setting up a broadband modem and a VPN ("virtual private network") for you and then giving you an 800 number to call if you have a problem. That's what they're selling.
The only value-add that I can see is the "Covisint OnDemand Platform" which is a generic collaboration software application (think Netmeeting) that also provides a single login for applications in the network. I guess the other value add is that the state has negotiated pricing and is providing grants (by way of various federal grants) for physicians and clinics to pay for the network connectivity. If I understand it correctly, they will still need software and systems for medical records and other clinical applications.
The article doesn't mention that there are several competing electronic medical records applications, multiple regional electronic records networks operating in the state and that they use different software and databases, or that usage among hospitals, clinics, and physicians isn't universal, and that there aren't really any standards for exchanging electronic medical records.
Gov. Bredesen should be applauded for his "eHealth" initiatives, because there is no doubt that better access to better medical records will improve health care and reduce costs.
There is also no doubt that the U.S. is way behind on the use of electronic medical records. According to a 2006 report by the Commonwealth Fund, only 28% of U.S. primary care physicians use electronic medical records, as compared to 98% in the Netherlands, 92% in New Zealand, 89% in the U.K., and 79% in Australia.
So it is good to see Tennessee taking the initiative. But this deal looks more like a way to funnel federal grant money to AT&T than any kind of breakthrough statewide electronic medical records system. It also takes more money out of our health care system in the form of profits for AT&T. But, the state can't operate it's own internet, so it makes sense to outsource that and to negotiate the best deal. Were other backbone providers invited to bid?
We have a long way to go before the U.S. has a reliable electronic medical records system in place. Medicare reporting is the closest thing we have to a standard, but it's mainly for billing. The federal government should take the lead in establishing standards for records storage and exchange, certifying vendor compliance, and regulating the industry to ensure accuracy, privacy, and reliability. Leaving it up to the states will result in a hodgepodge like we have in Tennessee multiplied times fifty.
Disclaimer: I am not an expert on any of this and am happy to be educated on what standards and systems are available and how they are being deployed and regulated.
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