Pay for performance

Five (Not So) simple steps to EHR

1. Figure out the business case. Individual practices may find they can pay for an electronic health records system (EHR) from saved costs, increased administrative efficiencies and, sometimes, increased patient flow.

2. Get buy-in. Make sure you get buy-in from all the doctors in your practice. The doctors must be committed as a group, and systems and practices must be uniform or the value of the EHR diminishes.

3. Consider your options. Give yourself plenty of time to decide how to go about funding the EHR system. Look to see if health information networks and pay-for-performance plans are available. These can make it easier to build a business case for EHRs.

4. Ensure support. Negotiate contracts to ensure that your vendor doesn't walk away after the implementation. Make sure contracts include ongoing training, service and support.

5. Prepare to change. EHRs force doctors, nurses and staff to change what they do, which creates potential for disgruntlement. Have a strategy to minimize these stresses.

The electronic bogeyman

First came the news that Brigham and Women's Hospital in Boston had been mistakenly faxing confidential medical records to a local investment bank over a period of six months. Then, on the very same day in February, the press reported that U.S. doctors had been faxing confidential patient information to a small Canadian distributor of herbal remedies, also by mistake.

Imagine if those sensitive medical records were electronic and mistakenly got zipped off to a company e-mail list. Or hacked by crackers.

That fear looms large for 86 percent of Americans, according to a recent survey by Health Industry Insights (HII), a unit of IDC (a sister company to CIO's publisher).

"People are concerned about the ramifications of being treated for depression or having AIDS and having [that information] spill over into their personal lives and their jobs," says Marc Holland, author of the survey and program director of Health Industry Insights.

HII surveyed 1,095 Americans on various aspects of electronic health records (EHRs). Among its findings, 86 percent of respondents said they were somewhat or very concerned about having their confidentiality breached if electronic health records become commonplace.

Holland said that without substantial public education efforts, fear over privacy would be a major challenge in getting people to use EHRs.

In addition, only 40 percent of those surveyed believed electronic health records would improve their care, and less than 35 percent thought EHRs would reduce the cost of care.

"What people don't realize is that more people are killed by error than by cancer," says Shannon Brownlee, Bernard F. Schwartz Senior Fellow at the New America Foundation, a think tank in Washington, D.C. Brownlee says she doesn't think that privacy issues will derail EHRs.

"Somehow we've managed to find ways to put our banking records online, take money out of a machine using a little wallet-sized card, and purchase goods over the Internet, all without an undue loss of financial privacy," Brownlee says. "Why on earth wouldn't we be able to find ways to keep medical records private?"