Health-Care Technology: Patient Involvement Helps

A new study shows the participation of patients in the use of electronic medical records can improve the effectiveness of the system

As President Barack Obama pushes for the use of more information technology in the health-care sector, a new study suggests that getting patients involved in the effort, along with hospitals and doctors' offices, can lead to substantial benefits. The research, conducted by Harvard Medical School and two other institutions, shows that reminding patients to take a critical cancer test is actually more effective than reminding their doctors about the same test. "When we talk about improving the health-care system, what we should do is also talk about how we can take advantage of our patients as a resource," says Thomas Sequist, one of the study's authors and an assistant professor of medicine and health-care policy at the Harvard Medical School, and Brigham & Women's Hospital.

The report comes just as the Barack Obama Adminstration is undertaking an ambitious effort to overhaul U.S. health care. The economic stimulus package Obama signed into law on Feb. 17 includes roughly $20 billion to help convert wide swaths of the industry to electronic health records. Experts have said for years that information technology could improve the productivity, efficiency, and safety of the health-care industry. But hospitals and doctors have resisted making technology investments, in part because they have had to bear most of the costs of technology while they reap few of the benefits.

The Obama approach aims to change the financial calculation for health-care providers. The government will give up to $65,000 to each doctor's office and $11 million to each hospital that shows meaningful use of digital records. (To be eligible, the health-care providers need to participate in Medicare, the government health-insurance program for the elderly. There are similar financial incentives for Medicaid participants.) In addition, the government will spend about $300 million to create regional data exchanges, making it easier to maintain comprehensive patient records as people switch between doctors offices, hospitals, and pharmacies.

The government will also begin penalizing health-care providers that resist the adoption of electronic records. Doctors who don't begin using the technology by 2015 will stop getting inflation adjustments for Medicare payments. The goal is to make all health-care records digital within five years. "It's a combination of a carrot and a stick," says Karen Davis, president of the Commonwealth Fund, a nonprofit research group in New York.

Stimulating Change

Both are needed, says Davis. According to the Commonwealth Fund, 25% of doctors' offices have digital records of some kind, though Harvard's Sequist estimates that only 5% have sophisticated digital records that allow their offices to operate largely without paper. Besides the cost of implementation, doctors drag their feet because of confusion about the systems and which standards to use, concerns over patients' privacy with new tech systems, and because of an unwillingness to change the way they do business.

The stimulus package may be an effective way to address those issues. The Commonwealth Fund estimates that implementing e-records in a typical doctor's office costs $40,000 in technology and lost productivity. About $2 billion of the money allotted is being set aside for the Office of the National Coordinator for Health Information Technology, or ONC. The George W. Bush Administration tapped the office to spearhead a similar push for electronic records, but the effort suffered from several shortcomings, including a shortage of funds, observers say. The ONC is now in charge of meeting a deadline for setting standards this year and having them tested and certified next year.

Employers are showing an increasing interest in electronic records, too. Last year a coalition of several large companies, including Intel (INTC), BP (BP), Pitney Bowes (PBI), and Wal-Mart (WMT), began trials involving electronic records for their employees. In November, Wal-Mart conducted a major rollout, offering electronic records to 1.4 million of its employees. Participants can get access to their electronic records, which include blood tests, prescriptions, and medical visit history, by logging on to the company's Web site. Google (GOOG) and Microsoft (MSFT), meantime, are trying by providing online health records aimed directly at consumers, rather than employers.

As the industry moves forward with electronic records, it makes sense to start thinking about how they can be used most effectively, says Harvard's Sequist. Rather than putting all the emphasis on how physicians will use e-records, the focus also has to be on how e-records can be used to get patients more involved in their care, the study's researchers say. "We have to think about more effective ways to use these electronic records during visits, given all the expectations we have for primary care," says John Ayanian, one of the study's authors and a professor of medicine and health-care policy at Harvard Medical School and the Brigham & Women's Hospital.

Patient Reminders

Sequist and his colleagues based their study on 300,000 digital patient records used by the Harvard Vanguard Medical Associates, a group practice in Massachusetts that has had electronic records for 12 years. The researchers pinpointed 21,860 patients who were overdue for colorectal cancer screening and 110 physicians who worked with those patients.

The researchers focused on colorectal cancer because it's second only to lung cancer as the leading cause of cancer death. Compared with other cancers, it's relatively easy to prevent and detect with screening. Yet only 60% of adults 50 to 80 get screened regularly.

The next step was to split the patients and doctors into sample and control groups. Then they sent personalized letters to the sample patients, explaining that they were overdue and providing information about testing. The doctors saw little pop-up reminders when they looked at the electronic records during office visits with the patients.

After 15 months the researchers found encouraging changes. About 44% of the patients who received a reminder went for a screening, compared with 38% who didn't receive a reminder. "We were pleased to see the effect of the patient mailings; this is the group despite all of the public education that hasn't yet chosen to be screened," says Ayanian.

More striking was that the reminders to the doctors didn't lead to any major increase in screening rates. Other studies have shown, says Ayanian, that doctors are often so busy during patient visits that they don't have time or they don't remember to talk about screenings. That's just one way that e-records can become more powerful, the researchers say. By developing data mining systems that can comb through the information stored in patients' records, the health-care system can come up with new ways to empower patients.

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