I'm not sure if this tread is a good thing or a
bad thing.  On one hand I can hear the "big
brother is watching us," on the other hand, I see
someone attempting to look out for me.  My local
health care system has gone digital.all the paper
records are now in storage in a warehouse.so when
I see my Internist I go through a Triage process,
then I see the doc, when uses the monitor screen
to show me the results of blood work.  The same as
NY!  Yes it allows all docs within the system to
see me the same.no hand written notes to decipher.
But at the same time, there I am for the
government to see, AND what happens within the
insurance industry.  What if they are able to
gain.despite HIPPA.access to my records?



Carolyn



February 26, 2008


New York City to Help Doctors Track Patients'
Records Electronically


By MARC
<http://topics.nytimes.com/top/reference/timestopi
cs/people/s/marc_santora/index.html?inline=nyt-per
>  SANTORA

New York City to Help Doctors Track Patients'
Records Electronically

http://www.nytimes.com/2008/02/26/nyregion/26healt
h.html?ref=nyregion

After two years of planning and a public
investment of more than $60 million, Mayor Michael
<http://topics.nytimes.com/top/reference/timestopi
cs/people/b/michael_r_bloomberg/index.html?inline=
nyt-per>  R. Bloomberg said on Monday that New
York City was ready to equip doctors with computer
software that can track patients' medical records
in order to provide better preventive care.

While not mentioning anyone by name, Mr. Bloomberg
used his press conference in the Bronx on Monday
to criticize national political leaders for
failing to address the issue of disease
prevention, which he considers a more significant
problem than either the lack of access to health
care or skyrocketing costs.

"People keep talking around in circles and no one
ever does anything and it just keeps getting worse
and worse," Mr. Bloomberg said. "By bringing this
health technology to New Yorkers, we are building
a national model for a health care system that
works, by preventing illness rather than merely
treating people after they're already sick."

The electronic tracking system, he said, is just
the beginning of an effort to provide better care
to people before they get sick, but he called it
an essential step.

"Sadly it is only for New York City," he said.
"Hopefully, the rest of the country and the rest
of the world will learn."

The new system, a software package developed with
$30 million from the city and roughly $30 million
from the state and federal governments, would let
doctors do much more than is possible with paper
charts by integrating a patient's medical history,
lab results and current medications into one
electronic interface.

Among its important advances, city officials said,
the system will give up-to-date information to
doctors through a series of alerts, like overdue
dates on prescriptions
<http://health.nytimes.com/health/guides/specialto
pic/getting-a-prescription-filled/overview.html?in
line=nyt-classifier>  or cholesterol
<http://health.nytimes.com/health/guides/nutrition
/cholesterol/overview.html?inline=nyt-classifier>
checks. It will share data with other doctors and
provide information about the current best
practices for treating illnesses. City officials
hope that the system will help reduce overall
costs by eliminating expensive and repetitive
tests.

Two hundred doctors with 200,000 patients have
committed to use the system, and the city hopes to
have 1,000 doctors with one million patients using
it by the end of the year, said Dr. Thomas
<http://topics.nytimes.com/top/reference/timestopi
cs/people/f/thomas_r_frieden/index.html?inline=nyt
-per>  R. Frieden, the New York City health
commissioner.

Dr. Frieden said the system would provide more
finely tuned information to doctors quickly than
anything now available.

"This can do for health what the Bloomberg
terminal did for finance," he said in an
interview.

The system will also allow the health department
to get general data from health care providers on,
say, how well patients are controlling their blood
<http://health.nytimes.com/health/guides/test/bloo
d-pressure/overview.html?inline=nyt-classifier>
pressure, but the department will not have access
to specific information on any individual patient.
That information will be restricted to doctors and
their patients.

To encourage doctors to use the system, the city
will underwrite part of the expense for eligible
doctors, paying for licenses, on-site training,
tools to use the software and two years of
maintenance and support.

Any doctor who has a practice where 30 percent of
the patients are either uninsured or on Medicaid
<http://topics.nytimes.com/top/news/health/disease
sconditionsandhealthtopics/medicaid/index.html?inl
ine=nyt-classifier>  is eligible for the
assistance, but the city is also asking that they
provide their own computers, and contribute $4,000
to the Fund for Public Health in New York for
continuing technical support. Dr. Frieden said the
city wanted to ensure that the medical practices
were invested in the system.

Any doctor who does not meet the eligibility
requirement can buy the software from the vendor,
eClinicalWorks, which helped create the
technology.

The system, city officials believe, could provide
the groundwork for drastically changing the way
doctors are reimbursed, starting with publicly
financed programs like Medicaid and Medicare
<http://topics.nytimes.com/top/news/health/disease
sconditionsandhealthtopics/medicare/index.html?inl
ine=nyt-classifier> .

There is little incentive for doing simple things
like ensuring that patients get generic
medications to control their blood pressure. The
data collection system would allow government
programs to compare outcomes, and to compensate
doctors based on the most effective practices.

There is little the city itself can do to
restructure reimbursement, and payment schedules
remain one of the more difficult issues to address
despite agreement among many experts on the
necessity for a change.

The electronic tracking of patients' health care
records, long thought to be simply more efficient
than paper records, has been attempted
sporadically across the country, with
Massachusetts currently using the most ambitious
program. In the past, such tracking of medical
records has raised privacy concerns.

"There are aspects of electronic health records
that are scary," Dr. Frieden said. "If you have a
breach, it can be a bad breach."

The system developed by the health department, he
said, has extensive safeguards - including the
ability of a patient and doctor to see exactly who
has gained access to the records and to lock
certain data behind a firewall so it can be seen
only by the primary care physician if the patient
wishes.

The technology will be uncopyrighted open-source
material, Dr. Frieden said, allowing as many
companies as possible to use the system as a
model.

Dr. Frieden concedes that medical practices will
most likely see a decrease in productivity for
about six months as doctors' offices become
familiar with the technology and transfer data
from paper records or other systems.

As the system gets wider use, Dr. Frieden said, it
will become easier to measure results with some
precision. But in order to improve patient care
greatly, he said, it is critical to change the way
doctors are compensated.

"Whether this can work without a change in
reimbursement remains to be seen," he said.

It is very difficult to measure how well a doctor
is doing at preventing a disease, but the
statistics are dismal, Mayor Bloomberg said. For
instance, 75 percent of those with high
cholesterol fail to get it under control, Dr.
Frieden said.

Experts have been calling for years for a
reimbursement system that better rewards good
outcomes, but Dr. Frieden said one of the problems
has been the lack of reliable tools to measure
what doctors are doing.

"We are laying the ground for allowing it to
happen," he said.

It remains to be seen if doctors are willing to
subject themselves to such close scrutiny, but the
initial response to the program was encouraging,
city officials said.

A similar system across the country would cost
some $20 billion, Mr. Bloomberg said. Given that
the nation annually spends $2 trillion on health
care - a figure that keeps rising every year - he
said it was a small investment that could have a
large return.

Mr. Bloomberg called for setting a national goal
of requiring every doctor who gets money from
Medicaid and Medicare to be using an electronic
medical record system focused on prevention by
2012.




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