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Terrorist
Attacks Highlight Need For Electronic Medical Records
By LAURA LANDRO
Staff Reporter of THE WALL
STREET JOURNAL
ELECTRONIC MEDICAL RECORDS that could instantly
supply a person’s blood type, allergies and past treatments
could help save lives in an emergency, many experts agree. The technology
exists to share such personal data on the Internet, but efforts
to implement a nationwide system have been stymied by high costs,
a highly fragmented health-care system and privacy concerns.
Last week’s terrorist attacks highlighted
the need to get U.S. hospitals wired, say emergency physicians and
medical-information specialists. “It is amazing that none
of the plans for post-Sept. 11 life demand that electronic health
records be a priority,” says C. Peter Waegemann, executive
director of the private Medical Records Institute, which promotes
use of electronic records.
But hospitals would have to invest in new
systems to collect and use the information, and many are operating
in the red. “The health-care system is almost as strapped
as the airline industry,” Mr. Waegemann says. “It will
take funding, and someone with the political will to say we need
this.”
 Mr.
Waegemann contends that electronic health records could improve
peoples’ chances of surviving in emergencies. The most pressing
need is to inform doctors of a patient’s medical conditions
or drug allergies for immediate trauma treatment. But electronic
access to dental records or other personal medical data also could
help identify victims who don’t survive. “In a mass
casualty situation, we need to be able to rapidly access medical
information,” adds John Halamka, an emergency medicine physician
and chief information technology officer at Boston’s Caregroup
hospital system. “We don’t have the time or luxury of
taking a medical history.”
THE MEDICAL RECORDS Institute
estimates that only 5% to 10% of health-care providers now use paperless
record-keeping systems. Hospitals generally don’t have information
systems that allow them to share patient data within their own internal
departments, let alone with other hospital systems.
Even if individual physicians do keep electronic
patient records, they might not include data from all specialists
treating the same patient, such as dentists. And some worry that
an emergency breakdown in communications systems could render electronic
records useless. For that reason, California, for example, requires
health-care providers relying on electronic records to have an offsite
backup system, or keep paper copies.
Recently, various government advisory groups
have been working on ways to create a national health-data network
in which a patient would consent to have his or her medical records
put online in a secure, password-protected site. In addition to
aiding individual treatment, such a network could also identify
clusters of health problems and provide an early-warning system
for outbreaks of serious illness.
It also could help deliver a wide range of
medical data to physicians and promote so-called telemedicine systems,
which allow doctors in one place to help treat patients far away.
But such efforts are at an early stage, and proponents are just
starting to deal with issues such as technical standards.
THE ATLANTA-BASED Centers
for Disease Control and Prevention is developing uniform specifications
for data entered in emergency-department patient records, covering
over 150 data elements. The program envisions linking emergency
rooms and public-health departments via secure servers. Among other
uses, it could help quickly identify health threats. Daniel Pollock,
acute-care team leader at the CDC’s injury prevention center,
says pilot projects in Oregon and North Carolina have shown how
important such systems are in emergencies such as floods and hurricanes,
which also create long-term public-health problems.
In Indianapolis, five hospital systems have
begun sharing some data on a network that can report patterns to
health officials. Clem McDonald, director of the Indiana University-affiliated
program, says the network could provide a warning system for things
like biochemical attacks.
Patients have to get over their privacy fears,
says Todd Taylor, an emergency-care physician in Arizona. “People
get so concerned about having their medical records on a computer,
but don’t give a second thought to handing their credit card”
to a restaurant, Dr. Taylor says.
The Department of Health and Human Services
in July issued the first in a series of privacy guidelines for medical
records and other personal-health information. Hospitals and health
plans are required to comply by April 2003.
Dr. Taylor says new privacy rules have good
intentions but are sparking fear among hospitals “because
penalties for violating the law are so severe.” But Joy Pritts,
senior counsel at the Health Privacy Project at the Institute for
Healthcare Research and Policy at Georgetown University, says she
believes the rules, when properly understood, will encourage use
of electronic medical records, while providing the security needed
to prevent personal data from being improperly used.
She adds that emergencies are exceptions to
such concerns. “Whether it be a situation of mass casualties
or an individual in a car accident,” she says, “the
regulations recognize that there are times when doctors need access
to health information immediately to treat a patient.”
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