New York Times Examines How EHRs Could Improve Evidence-Based Medicine

The New York Times last week examined how "widespread adoption of electronic health records might ... greatly increase evidence-based medicine," among other benefits. The article is part of an occasional Times series called "The Evidence Gap." According to the Times, "Each patient's records adds to a real-time, ever-growing database of evidence showing what works and what does not" that could allow physicians to "harness health information from individuals and populations, share it across networks, sift it and analyze it to make the practice of medicine more of a science and less an art."

The Times profiles the Marshfield Clinic in Wisconsin, which uses a number of health information technology tools to improve health care quality and efficiency. The Times reports that the Marshfield experience suggests that EHRs become "truly useful only when patient information is mined to find patterns and answer questions," such as what treatments work best for certain groups of patients, and what procedures result in the best outcomes?

While the Bush administration largely has relied on advocacy groups and the private sector to promote the use of health IT in the U.S., President-elect Barack Obama "apparently plans to make a sizable government commitment," the Times reports. Obama during his presidential campaign said he would spend $50 billion over five years to encourage the use of EHRs and more recently has said that he would include funding for EHR promotion in an economic stimulus package.

According to the Times, the challenge for the incoming Obama administration and future administrations will be "to somehow link electronic medical islands into a network that begins to approach on a national scale what organizations like Marshfield have achieved regionally." Some experts say that "such a broad capacity for record-sharing could take decades to achieve -- if it is even possible in the decentralized American marketplace of medical competitors," the Times reports (Lohr, New York Times, 12/27/08).

NYC EHR Project
The New York Times last week examined a $60 million New York City Department of Health and Mental Hygiene project to build a shared electronic health records system among the city's primary care physicians. In the project, designed by eClinicalWorks, the city is attempting to provide access for a majority of the city's medical practices -- most of which have 10 or fewer physicians -- to a larger database of information so that physicians can improve preventive health care. According to the Times, experts call the project "the most ambitious government effort nationwide to harness electronic data for public-health goals."

The database will convey recommendations on how to address medical problems based on a patient's age, sex, ethnic background and medical history. It also will prompt physicians to give routine tests and vaccinations, inform them how to best treat specific illnesses and warn them of potentially dangerous drug interactions.

The project is being marketed most aggressively in Harlem, the South Bronx and central Brooklyn -- three of the city's lowest-income areas, the Times reports. Implementing the system would cost a typical practice $45,000, but with city subsidies, practices with at least 10% of patients who are enrolled in Medicaid or are uninsured will pay $24,000. Practices in neighborhoods with the highest poverty rates will pay $10,000, according to the Times.

More than 1,000 of the about 10,000 primary-care physicians in the city are participating in the project, and 500 are "in the pipeline," according to the Times. Participating physicians in April 2009 will begin receiving report cards that evaluate their preventive efforts against those of their peers. In addition, the health department will soon begin offering bonuses of up to $100 for each patient who reaches specified goals, such as lowering blood pressure or cholesterol levels. Each physician could receive up to $20,000 in bonuses, according to the Times (Hartocollis, New York Times, 12/30).