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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. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn