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November 2007 — Vol. 2, No. 11

In This Issue

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Terms and Definitions

Personal Health Record (PHR): The HIMSS definition: An electronic personal health record (“ePHR”) is a universally accessible, layperson comprehensible, lifelong tool for managing relevant health information, promoting health maintenance and assisting with chronic disease management via an interactive, common data set of electronic health information and e-health tools. The ePHR is owned, managed, and shared by the individual or his or her legal proxy(s) and must be secure to protect the privacy and confidentiality of the health information it contains. It is not a legal record unless so defined and is subject to various legal limitations.

HIMSS PHR Definition and Position Statement: View the HIMSS PHR definition and position statement on the use of personal health records.

Patient Portal: To understand how a patient portal works, begin with the definition of a Web portal: A Web portal is a Web site that provides a starting point, a gateway, or a portal to other resources on the Internet or intranet.

Thus, a patient portal is the starting point for a patient to find information, set appointments, review lab results and/or view general health information on a physician or hospital Web site.

Source: Web portal definition from the HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations, HIMSS, 2006, p. 95

News Briefs

Healthcare’s New Consumer: “Communicating with the New Consumer,” by Melvin F. Hall, appeared in the March 28, 2007 edition of the Healthcare’s Most Wired Online. In this article, learn more about today’s healthcare consumer and four trends that affect how consumers view and use healthcare. 

A Legislative Perspective on Electronic Personal Health Records
The administration, Congress, foundations, and the private sector have undertaken various initiatives to promote the adoption of electronic health records (EHRs) as part of the national health information infrastructure. An electronic personal health record (EPHR) is a database of medical information collected and maintained by the individual patient. Commercial suppliers, health care providers, health insurers, employers, medical websites, and patient advocacy groups offer EPHRs.

Congress has held hearings on electronic personal health records, and legislation has been introduced (S. 1456), ordered to be reported (H.R. 2406), and reported (S. 1693). Electronic personal health records are controversial among privacy advocates and patients, who are concerned about health information privacy and security, and misuse of individually identifiable health information. The extent to which electronic personal health records are protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule is discussed in the report.

Health Recovery Records - Lessons Learned from Hurricane Katrina: Find out how Christy L. Valentine, MD, rebuilt her medical practice in New Orleans with help from the HIMSS Katrina Phoenix project and the Louisiana Quality Improvement organization.

Kaiser Permanente Introduces My Health Manager Personal Health Record: Read the news release on this personal health record system that was introduced in early November. More than 1.6 million members of this health plan have signed up to use this PHR. 

CCHIT Update


Newly certified ambulatory products
The Certification Commission announced that nine EHR products for office-based physicians have been certified under the 2007 criteria, bringing the total number of product certifications to 98 – or an estimated 40 percent of the ambulatory vendor marketplace – since the program began in 2006. The newly certified office-based EHR products are listed on the Commission’s Web site, www.cchit.org. 

Additional CCHIT Activities
The Certification Commission announced earlier in 2007 that it will also be specifying certification criteria for EHRs used in additional care settings, such as nursing homes, and by specialized health care providers, such as behavioral health. Development work is expected to begin in 2008. “Making certified EHRs available to additional health care providers and settings, will support adoption of EHRs and move us towards the President’s goal that most Americans have an EHR by 2014,” said Dr. Robert Kolodner, the National Coordinator for Health Information Technology.  

MITRE-CCHIT Health IT Collaboration Effort – “LAIKA” Reports Progress
The MITRE Corporation and CCHIT announced in early November the next phase in their collaborative effort to build a testing resource to evaluate compliance of electronic health records (EHR) and networks with interoperability certification criteria. The effort, named “LAIKA,” is an open source software testing framework, distributed via an Apache 2.0 open source license. This development effort will make it easier for electronic health record vendors to test and verify that their products support standards-based information exchange capabilities and prepare for CCHIT certification. LAIKA will be a free and publicly available EHR testing tool with an anticipated release date of version 1.0 by March 21, 2008. Visit www.cchit.org to read the complete news release.

About the Certification Commission

The Certification Commission for Healthcare Information Technology is an independent, nonprofit organization that has been officially named by the federal government as a “recognized certification body” for health information technology products and networks. Its mission is to accelerate the adoption of health information technology by creating a credible, sustainable certification program. The certification requirements are based on widely accepted industry standards and involve the work of hundreds of expert volunteers and input from a variety of stakeholders throughout the health care industry. More information on the Commission and CCHIT CertifiedSM products is available at www.cchit.org.

“CCHITSM” and “CCHIT CertifiedSM” are service marks of the Certification Commission for Healthcare Information Technology.


State Dashboard

Visit the State Dashboard for More Information on RHIOs/HIEs

HIT Dash

HIMSS is currently seeking members interested in applying for a Davies Award committee appointment. Any individual or corporate complimentary member, who is not already serving in a leadership capacity within the Society, is welcome to apply. Individual members of HIMSS are ineligible for a Davies Committee appointment is they are either (a) employed by a vendor company or (b) directly working in an extensive consulting capacity with/for a vendor company. Applications will be accepted between October 15 and December 5, 2007. For more information, contact David Collins at 703-562-8817 or dcollins@himss.org

Links you need to know:
Important Information Before Applying For a Davies Commitee Position
HIMSS Davies Committee Application

Your peers belong.
Your mentors belong.
You belong in HIMSS.

Join or renew today

SPECIAL EDITION - Personal Health Records (PHRs) are Here: How they are Affecting the Practice of Medicine


Digital Office Earns Gold Award in LACP Competition

The HIMSS Digital Office enewsletter received a Gold Award in the League of American Communications Professionals LLC (LACP) 2007 Spotlight Awards competition. The Digital Office ranked 110th out of 904 entries with a score of 95 out of 100 possible points. In the competition class ranking for “Web: Newsletter/Magazine,” the enewsletter placed second out of 16 entries.

LACP is an organization dedicated to supporting and recognizing excellence in the practice of professional communications, released the results of this year’s print, video & web communications materials competition, the 2007 Spotlight Awards. The competition was judged by a field of communications professionals affiliated with LACP. Their expertise spans a broad spectrum of public relations functions ranging from corporate, executive, and internal communications for Fortune 500 organizations to product, service, and non-profit publicity experience. Judges are screened to ensure that there are no conflicts of interest. 

“This year’s entry, ‘HIMSS – The Digital Office,’ proves to be remarkable in light of the tremendous competition,” said Christine Kennedy, LACP managing director. “More than 900 entries were received for the 2007 Spotlight Awards, comprising communications materials from seven countries.”

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Lesson Learned from Cleveland Clinic's Dynamic PHR-Enabled Patient Community

by C. Martin Harris, MD
Chief Information Officer, Cleveland Clinic
Executive Director, eCleveland Clinic
Member, HIMSS Board of Directors

Over the course of the past two years, Cleveland Clinic introduced eCleveland Clinic MyChart®, the personal health record extension of our organization’s enterprise-wide commitment to transforming the contemporary medical practice model through the application of integrated health information technologies tools. 

MyChart has proven so popular that nearly 40 percent of the patients visiting our 13 Northeast Ohio family health center facilities this year used this relatively new service to manage appointments, receive test results, renew prescriptions and access personalized health information about their individual issues and concerns. With thousands of new MyChart users signing-up each month, we have had the opportunity to form an understanding of how real patients use an online personal health record in real life. The following two insights are derived from our experience servicing the tens of thousands of Cleveland Clinic patients who use a secure, online tool to interact with the medical professionals from whom they receive their care.

Integration

At Cleveland Clinic, we did not introduce the MyChart PHR service until a major information technology implementation project successfully e-enabled our organization’s ambulatory medical practice. Involving multiple Ohio locations, as well as our Florida facilities, the electronic medical record system presently in place effectively creates a single, efficient practice environment that connects any caregiver to any information they need, wherever and whenever they need it.

The cultural impact of this technology-driven connectivity has been enormous, resulting in a practice model in which health information management tools support virtually every aspect of our clinicians’ daily activities—which is a key point. Increasingly, the demands on a physician’s time and attention are forcing healthcare providers to work smarter. To a significant degree, Cleveland Clinic’s MyChart service is successful precisely because it is integrated directly into our practice’s standard work flow. Any PHR that is perceived by provides as an “add on” service, or that requires additional physician effort to maintain, will not be as effective as a service that enhances a physician’s ability to deliver quality patient care without adding additional, time-consuming steps to an already busy practice day.

Commitment to Service

For consumers, healthcare activities do not occur in a vacuum. From managing a household checking account on a local bank’s Website to ordering movie tickets online, Internet-based transactions have redefined consumer expectations regarding service and convenience. By introducing MyChart to a predominantly Web-savvy consumer population, we at Cleveland Clinic understood that our PHR would inevitably be compared to and, in a sense, compete with other, more mature online service offerings. And while it was clear that MyChart could improve the relationship our organization shares with our patients, it was equally apparent that, should our service fail to live up to our patients’ expectations, we could easily disappoint the very people we work so hard to serve.

As already stated, the first step we took to guarantee MyChart’s success was to integrate the service directly into our medical practice model. As a second step, we made a conscious decision to safeguard our patients’ PHR experience by clearly delineating exactly what services MyChart would deliver after securing a commitment from Cleveland Clinic caregivers that they would support the service as described. While the convenience aspects of MyChart, such online prescription renewal capability, are attractive features, our patient users clearly find the service’s greatest value to be their connection to the personal health information released by their physicians. Therefore, as part of the eCleveland Clinic program, we are in constant communication with patients and physicians, assessing satisfaction and assessing potential new MyChart services, to ensure that both sides of the physician/patient relationship experience all the benefits the service has to offer.

As more media, consumer, and provider attention is paid to the personal health record as both a concept and a tool, it is perhaps inevitable that PHR products of various quality and usefulness will arrive in the market place. As medical and health information technology professionals, we have an obligation to contribute our expertise to the national PHR conversation. At Cleveland Clinic, our experience continues to demonstrate that the most effective PHR, for both consumers and physicians, is one that is integrated directly into a health information technology-enabled practice model supported by healthcare providers who are committed to extending the same standards of quality they maintain in the exam room to every aspect of the relationship they share with their patients.

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Views From the Top

Holly Miller, MD, MBA
Chief Medical Information Officer
University Hospitals
Cleveland, Ohio
Chair of the HIMSS PHR Committee

Dr. Miller shared her thoughts with the Digital Office on the challenges and future of PHRs and providers. Leslie Spiece, senior project manager at Assurant Health, conducted the interview.

1. In your estimation, what is the current PHR climate?

In the US, we are experiencing an epidemic of behaviorally related chronic diseases, such as obesity, heart disease, and diabetes. Baby Boomers are aging, peaking in 2020 with 71.5 million 55 years old or older. It is no coincidence that the prediction for rising costs of healthcare for the year 2020 is estimated at over 20 percent of the gross domestic product.

But there is hope that, if we can direct current efforts at disease prevention, we can curtail some of these skyrocketing healthcare costs. Surveys have indicated that Baby Boomers want to be healthy, and believe that they can improve their wellness through healthy behavior. A well-designed personal health record (PHR) can provide the tools to support healthcare consumers to practice healthy behaviors and adhere to disease prevention programs, and chronic disease management regimens. Providers generally are limited to providing asynchronous care during the limited time available for them to interact with a patient at an office visit. PHRs can provide synchronous support with immediate, positive feedback to change behaviors. PHRs may ultimately evolve to providing contagious health, where behavioral change support may be found online through “communities of care” –such as diabetes buddies. So much can be done with online support systems and tools. 

2. What are the challenges of PHRs?

Currently providers continue to be concerned about some issues surrounding PHRs. For example, if a provider is offered to review a PHR and does not do so, are they liable for the information contained in the PHR? If healthcare consumers have access to all of their result information, will they call their providers with questions, thereby generating more work for the provider? 

In addition, many of the current PHR models that have broadly been implemented are provider tethered models, and healthcare consumers are interested in transportable interoperable PHRs that would include all of their health information, not just their information from one organization.  

3. The future?

Physicians are starting to enter a world where they will be paid based upon quality of services. In a pay-for-performance world, providers are rewarded based on quality standards. PHRs may help support patients to follow through with their physician’s recommended treatment plans, and help to improve the patient/clinician relationship and communication. 

In several instances, employers are starting to create employee financial incentives based on employee behaviors. For example, employees receiving cash benefits for quitting smoking or for an obese employee to lose weight  PHR tools may provide the needed positive reinforcement for employees to achieve their goals. 

Ultimately a portable, interoperable PHR that is owned and controlled by the patient may provide healthcare consumers with necessary tools to better manage their health and wellness throughout their lives.

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Patients Are Concerned about Privacy

By Lisa Gallagher, BSEE, CISM
Senior Director, Privacy and Security, HIMSS

Multiple surveys show that Americans are concerned about their privacy, especially privacy of their medical records. Stories in the media expose compromised medical databases, patient records viewed without permission (ala “George Clooney-syndrome” – an incident where healthcare workers were disciplined for inappropriately viewing George Clooney’s medical records1). At the same time, discussion abound about access and ownership to electronic health data - who controls access to the record and can the patient intervene to prohibit access by certain parties or to certain parts of the record?

Patients Keeping Their Own Records

In the midst of our current policy discussions around privacy, patient information often is found in many different locations and sometimes unavailable when needed. Some patients do keep their own records, albeit mostly on paper. Increasingly, some patients are interested in moving towards electronic storage of those records. PHRs offer these patients a seemingly easy and efficient way to do this, especially for patients with chronic disease or for health management.

Patients Trust Providers the Most

When asked about which entities that they trust the most, patients clearly place the most trust in their physicians. In fact, several surveys place doctors at the top of the patient “most trusted” list.

Not surprisingly, patients may be most comfortable sharing PHR data with their physician.

Privacy Implications for Physicians Related to PHRs

Interestingly, the privacy-related issues around use of PHR data by physicians are complex. In theory, the data contained in PHR are “owned” by the patient and the patient decides with whom and when the data is shared. Also, the patient can add to, delete or amend the data as they wish. Therefore, many physicians are concerned that:

Working out privacy, trust, workflow and data standardization issue are key to establishing physician interest in using PHR data. An excellent source of information on the future of PHRs, published by the California Health Care Foundation may be found at: http://www.chcf.org/documents/chronicdisease/PHRPerspectives.pdf

1 For related news coverage see Google News Search.

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A Brief History of MedicAlert's Use of Personal Health Records

By Ruth Gwinner and Martin Fisher

MedicAlert celebrated 50 years of helping save lives in 2006. Founded by Dr. Marion Collins after his daughter suffered an anaphylactic reaction to a skin test for tetanus antitoxin, MedicAlert delivered the first bracelets to physicians attending the Congress of American College of Surgeons in 1956. Since then, MedicAlert has grown to include more than 4 million members worldwide, with affiliate organizations in many other countries.

MedicAlert bracelets are engraved with information critical for treatment decisions, as well as the 800 number to reach our emergency response team. This team provides any updates or additional information regarding the member’s conditions, allergies and medications to the professional (doctor, nurse, EMT or police officer) that needs it. In other words, we speak when our members cannot. Last year, we provided critical information in the support of thousands of member emergencies.

To provide this information, MedicAlert created the first personal health records. Members call our contact center and we update their records, after appropriate review for accuracy.

Initially, we kept the records on cards in the basement and in the event of an emergency call, the person answering the call would rush down the stairs and retrieve the card, bring it back up and relay the information.  The team was in very good physical condition thanks to the exercise.

In 1967, MedicAlert transferred its member information data from handwritten records to microfiche, which saved the dash down stairs, but created its own problems. All record look-ups, including emergency calls, were done via alpha or numeric lookup first. If you only knew the name, you would search the alpha fiche first to obtain the member number. Once you had the member number, you would look it up on numeric fiche to get the location of the detailed fiche card. Then you would locate the member information on the detailed fiche card. This also involved weekly updating of fiche binders on site and at the disaster recovery location. 

In the early 1970’s, MedicAlert was one of the first organizations to computerize their records, which provided a ten-fold increase in record management capacity and a dramatically improved response time for emergency calls. We also added the ability to fax emergency specific data directly to hospitals.

The next upgrade to the personal health records occurred in 1990 when the system was upgrade to include the ability to store more detailed information, including advanced directives, do-not-resuscitate orders, medical device instructions and more. The ability to track and report on emergency calls was also added.

The “Y2K” issue prompted further upgrades, including PHR updates via the Web and non-emergency related data that members chose to include, starting the transition to a true personal health record.

This decade has seen the even more changes to our PHR, with the Electronic Health Key (EHK) delivered in 2005 and MA Gold delivered in 2006. The EHK is a USB device that allows members to carry a copy of their PHR and update it offline. The EHK will synchronize to the MedicAlert PHR when an Internet connection is available. MA Gold provides our members the capability to have paper information from physicians and hospitals converted into an electronic format and stored in their personal repository, giving the member true portability of data.

Currently, MedicAlert IT is developing the next generation of capabilities to expand the PHR to include more external information, such as prescription and test results. We have run pilots using RFID cards as identification allowing us to deliver information directly to health care centers. We will be able to interact with other systems through standard interfaces (Web services, CCR and so on) and ensure that emergency information is available to the EMT or hospital while the patient is in transit.

Many thousands of lives have been saved since Chrissie and Marion Collins acted on an idea. The idea, to create a body-worn identification emblem supported by a 24-hour emergency medical information service offering peace of mind, became a reality. It has withstood the test of time over the past 50 years. The original bracelet is now in the permanent collection of the Smithsonian Institution in Washington D.C. MedicAlert’s personal health record, having evolved from index cards to the Internet, plays a vital role in fulfilling the mission of our Foundation: to help protect and save lives.

MedicAlert has recently joined the HIMSS/COMCARE Emergency Advisory Board, to ensure that we will be able to continue to fulfill our mission of helping save lives by delivering critical medical data in time of need. With our experience in providing member data combined with our state of the art technology center we believe we can help deliver systems that will benefit everyone.

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Vendor Update

Working to Solve Health Care Fragmentation
Microsoft® HealthVault™

Today’s health care system is defined by both great achievement and great challenge. Breakthroughs in medical research and practice are improving and saving people’s lives. At the same time, health information is decentralized and isolated, existing only in file cabinets and disconnected servers. It is difficult for people to manage and share health information productively, or to navigate resources efficiently and accurately.

Technology can play a key role in helping solve this fragmentation. Microsoft has developed a technology platform called Microsoft® HealthVault™ -a privacy-and security-enhanced storage and sharing system, through which people can interact with health-related services—like personal health records, and devices that monitor everything from weight loss and exercise to blood glucose and blood pressure. HealthVault will bring the health and technology industries together to place people in control of their health care, while enabling seamless information exchange. Imagine the value of a resource that, with patient approval, allows a physician or pharmacist to access an individual’s entire health record and thus make better decisions about care and take informed action. 

With the support of a partner ecosystem that will develop these services and devices, Microsoft has committed to a platform that is of no cost to consumers, inclusive of industry standards and trusted through robust privacy and security safeguards. In order to make this possible, the platform includes three distinct applications.

More and more as people begin to create their personal health records and the devices available now and in the future, HealthVault will deliver the robust environment in which they can store and share what they need to, enabling them to make informed health decisions in partnership with their physicians and extended care teams.

Putting Members’ Health History to Work 

By David Fitzgerald, enterprise system architect manager, Aetna

Early in 2007, Aetna launched the CareEngine®-powered personal health record (PHR), a private, secure tool empowering members with a comprehensive view of their medical history, while giving them the opportunity to share this information with their physicians.

The personal health record is always working to help members achieve optimal health – monitoring new medical research, evaluating drug interactions, and communicating pertinent news and information to members and their physicians -- automatically.

The PHR stores and organizes health information into a single location for members. This makes it easy for members become more active participants in health care decisions by sharing pertinent data with their medical team.

A more complete health profile

Claims data is automatically entered into members' personal health record, giving an overall view of their health. Members can also add information that is not captured by medical claims – family health history, allergies, over-the-counter medications, recurring symptoms, and so on. Together, the claims data and self-reported information provide a comprehensive “health profile” and empowers members to become more actively involved in their health care.

The personal health record is integrated with Aetna’s proprietary CareEngine® technology, which analyzes members’ data, evidenced-based clinical guidelines and peer-reviewed literature to find errors in medical care as well as opportunities to improve care. Resulting messages and alerts, known as “Care Considerations,” are delivered to both the physician and the member’s personal health record so patient and doctor can make any necessary decisions.

To see a short video of Aetna’s Personal Health Record visit http://www.aetna.com/makehistory

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Thinking About…Adopting Health IT

Improving Health Care through Personal Health Records

Issue Brief – June 2007

Following are several stories on the PHR from the June 2007 edition of Issue Brief. This information is reprinted in the Digital Office with permission of the Blue Cross Blue Shield Association (BCBSA) and America’s Health Insurance Plans (AHIP).

There is consensus among diverse stakeholders across the health care system that the widespread adoption of health information technology will lead to safer, more effective health care. The challenge is to get health information quickly and securely where it is needed, whether that is to a physician’s office, hospital emergency room, health clinic, disaster site or a consumer’s personal home computer.

To support this goal, AHIP and the BCBSA have developed a model health plan-based personal health record and standards that will enable it to be portable, giving consumers the ability to take information with them if they change health plans.

Health Plan PHR Model

Personal health information is often dispersed piecemeal among a number of physicians, hospitals, pharmacies, and other health care providers. This lack of coordination within the health care system results in preventable medical errors, duplication of tests and procedures, and inefficient and inappropriate care.

Health plan-based PHRs are a potential solution that brings together information available from an individual’s insurer and provides consumers and their designated care givers an historical view of their health and encounters with the health care system.

Health plans are creating PHRs with information from physicians, hospitals, laboratories, and pharmacies. In some cases, individuals voluntarily add family histories, over-the-counter medications, advance directives, language preferences, and other key information to their PHRs. In July 2007, AHIP and BCBSA will begin work to add laboratory results to the current model. Health plans are adding additional features to the PHRs, such as interactive “walk me through tools,” preventive screening reminders and drug interaction alerts.

The Need for Standards

Until now, the information contained in PHRs has not been consistent or portable. AHIP and BCBSA worked with their member health plans and conducted consumer and physician focus groups to identify key information that should be included in PHRs.

But there were no existing standards for portability, which research says is a top priority for consumers. It is important for consumers to be able to conveniently take the information in their PHRs with them if they change jobs, switch health coverage or become eligible for Medicare.

To address the need for a portability standard, an Implementation Guide© was developed defining the standards and operating rules to allow consumers to transfer the health plan provided information in their PHRs with them after enrollment with their new health

In June 2007, AHIP and BCBSA began work to add consumer-entered data to the portability standard. The standards were pilot tested by 10 health insurance plans, validating that the model is workable. To ensure long term maintenance of the standards developed under this effort, AHIP and BCBSA have transferred the standards to ASC X12 and HL7 for further development, balloting and joint long-term maintenance.

Supporting Federal and State Efforts

AHIP and BCBSA support the federal goal of an electronic medical record for every American in an interoperable system. The industry’s work serves as an important first step; giving consumers immediate access to their personal health information, empowering consumers and their caregivers with information that will help accelerate provider adoption of clinical electronic health records.

AHIP and BCBSA will continue to work with public and private stakeholders and participate in ongoing initiatives to promote the use of information technology within the health care community.

Safeguarding Privacy and Security

Information in the PHR comes from data that health plans have from insurance claims, consumer-entered data, and other sources such as pharmacies. Prior to PHRs, this information has not been easily accessible to consumers, or available in a format that could help optimize their use of health care. But consumers must have confidence that the information in their PHRs will not be misused or inappropriately disclosed.

As such, in addition to the existing federal and state privacy and security requirements that health plans must follow, the industry has taken the additional step of adopting a new standard: consumers must be enrolled in their new health plans and give permission before PHR information is transferred to their new health insurer.

Consumer Outreach and Awareness Are Critical

Organizations representing people with chronic conditions and disabilities believe that consumers need PHRs to optimize their health, and that to promote the successful adoption of PHRs, it is important for the consumer community to be involved as they are developed.

In HealthTracks, our partnership with the National Health Council, which represents over 100 million Americans with chronic diseases and disabilities, we will increase understanding of PHRs and the value they bring. Together we will work to increase PHR regular use by these individuals and mobilize local health advocacy organizations to educate their members beginning in Northern California and Massachusetts.

Implementation is Underway

Health plans are rapidly working to implement PHRs that conform to the health plan PHR model developed and endorsed by our industry that includes portability by the end of 2008.

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Already There…Adopted Health IT

Electronic Records Part of Solution to Health Care Crisis      

By Joe Castelli, MD, Medical Director of Informatics at Murfreesboro (Tenn.) Medical Center

We are all aware that health care is one of the dominant issues of our time. After the war in Iraq, the health care crisis is arguably the second most important issue facing presidential candidates this election cycle.

Health care is certainly one of the biggest domestic issues we face. But why? All of us are affected by the health care issue – both in regard to our own health and the way it impacts our bank account. Either personally or through our family members, we all have a stake in it. As a nation, we are spending more and more money on health care – currently around 16 percent of our gross domestic product, with spending growth outpacing GDP growth every year in the last decade In other words, that 16 percent will be steadily increasing.

Also, a recent report from the Census Bureau revealed there are 46.6 million Americans without health insurance – that’s 15.9 percent lacking health care coverage – more than ever before. And for the first time in several years, there has been growth in the number of uninsured children – now 8.7 million children have no health coverage. Less access to care equals more expense due to less availability of preventative care. To make matters worse, a 2007 study by the Commonwealth Fund reported that the U.S. is last in studied industrialized nations in term of access to care and quality of care despite spending the most money. A pretty bleak picture – no wonder it’s such a hot topic!

So what do we do with this problem breathing down our necks? Politicians debate the pros and cons of various types of funding programs. Meanwhile, there has been growing interest in the ways that improved quality of care could actually assist with some of the cost issues we face. In 2001, the Institute of Medicine outlined a road map to address the quality concerns in U.S. health care. A part of their solution is expanding health care use of the same basic information technology that has changed the world of manufacturing. In 2007, the Center for Information Technology Leadership funded a study reporting significant cost savings in the care of diabetic patients using strategies enabled by electronic health records. Many experts believe that by concentrating efforts on improving the quality of care, improvements in cost containment and therefore access to health care can also be addressed.

Electronic health records have been identified as the important tool to leverage this transformation. In fact, some authors have remarked that use of electronic health records will be as important to medicine as the stethoscope. In response, the President signed an executive order in 2004 requiring the Department of Health and Human Services to push efforts to ensure access to secure electronic health records for most Americans by 2014. According to research by the Markle Foundation, most Americans overwhelmingly support the use of electronic health records. Unfortunately, less than 25 percent of doctor’s offices in the nation utilize an electronic health record and even fewer hospitals.

The good news for the residents of Murfreesboro is that our local physicians and hospital are doing an above average job of acquiring and using health information technology. With the right tools in place, the health care providers of Murfreesboro expect to be contributors to the health care crisis solution by delivering the highest quality care possible.

Dr. Joe Castelli is a board certified OB/GYN and native of Murfreesboro. After finishing medical school at the University of Tennessee, Health Science Center in Memphis, he completed internship and residency at Vanderbilt University Medical Center. He started practicing at the Murfreesboro Medical Clinic in July 2001, and has served as the Medical Director of Informatics at the Clinic since 2006.

Reprinted with permission from the Murfreesboro Post newspaper, Nov. 4, 2007.

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