David Blumenthal

By one estimate, only 17 percent of U.S. doctors use electronic records. But the federal government has ambitious plans to create a network in which patient information is shared electronically among medical institutions. As National Coördinator for Health Information Technology, David Blumenthal is writing the rules under which the federal government will spend more than $21 billion in stimulus funds to get the job done (see “Prescription: Networking”). Blumenthal, previously a practicing physician at Massachusetts General Hospital in Boston, spoke with David Talbot, Technology Review’s chief correspondent.

TR: How long will it take to create a national health-information network?

David Blumenthal: The president has said that everyone will have an electronic health record by 2014. That is the goal we are working toward right now. We are trying to make the network available as fast as we can.

TR: Can health IT reduce the skyrocketing U.S. health-care costs?

DB: The Congressional Budget Office projected dollar savings from the [stimulus] legislation at about $12 billion over 10 years. I expect that the actual savings will far exceed that amount.

TR: How do we get around the potential problems with electronic systems–such as overwhelming physicians with data or actually causing medical errors?

DB: Electronic health records and other forms of health IT can certainly be improved, and there are examples of bad implementation and other problems. I still think that on the whole, across the country we’d be better off with universal availability of electronic health records. We’d have fewer errors, fewer missed diagnoses, less duplication of tests, and fewer adverse drug events.

TR: If health-IT systems reduce such errors and lead to fewer needless procedures, why haven’t the insurance companies stampeded to get them installed?

DB: The insurance companies have been able to pass along the costs of waste in our health-care system to their clients.

TR: You are setting the definitions of “meaningful use”–the criteria hospitals and physicians must meet to collect their cash incentives for installing IT. What will be in these definitions?

DB: I can’t speak to the specific criteria at this point. We are in the middle of writing the regulations, and the initial release is anticipated in December.

TR: You’re giving out $564 million for states to form health-information exchanges among medical providers. Why don’t even the most electronically progressive hospitals–including your own Mass General–already share their data?

DB: There has never been a business case for health-information exchange. As a matter of fact, there has been a negative case: if you give away your information, you may lose it. You may lose the patient.

DB: That’s right.

TR: The Institute of Medicine has said that between 44,000 and 98,000 Americans die every year from medical errors of various kinds, and that IT can help. Are patients dying because of a lack of information exchange?

DB: Patients are suffering because necessary information is not available at the point of care. With robust health-­information exchange, there can be improved quality of care and improved care coördination. Today, the average 65-year-old with five chronic conditions has 14 doctors and is on multiple medications.

TR: Do any technological barriers, such as conflicting standards, stand in the way of these hospital exchanges? Would we need to give everyone a national health-care ID to properly merge or reconcile their records?

DB: No. I think we have almost all the standards we need, but we have to get people to use them. And we can do this without a single health-care ID.

TR: Why not a single health-care ID? Wouldn’t that make things simpler?

DB: We have a big job ahead of us to achieve widespread adoption and meaningful use of electronic records. We can get to where we want to go without a single health-care ID.

TR: Was the changeover to electronic records difficult for you personally?

DB: At some time over the last 10 years, I was basically required to use electronic records. I learned it gradually over time. As I got more capable, I became increasingly convinced of its value in clinical care. It was making me a better physician.

TR: How, for example?

DB: A couple of years ago, I saw a patient with a urinary-tract infection. I entered the order for Bactrim [a sulfa drug] on my computerized physician-order-entry system–and a warning came up saying this patient is allergic to sulfa. I am sure in the paper record there was a record of that, but it’s often easy to overlook things in a voluminous paper record. That kind of gain, repeated hundreds of thousands of times across the country, can result in real improvements in care.