Hospitals are slow to move away from paper records. Source: Providers Edge

EHRs are considered the answer to improving care and reducing waste in healthcare, and yet approximately 90 percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records.

According to the Baltimore Sun, the reasons for the slow transition include an inertia-filled healthcare system, a scarcity of good software, no incentives for technology adoption and a lack of government leadership.

"It's hard to believe that America lags behind the world in adoption of the information technology that can save lives and make healthcare more affordable - yet that's exactly the case today," Sen. Edward M. Kennedy, D-Mass., who is a health IT advocate, reported The Sun. "Congress and the administration should make a commitment to bringing the nation's health system into the information age."

For example, in Denmark, 90 percent of the health system is computerized and Germany completed its healthcare digitization two years ago. The United States, however, does not have nationalized or otherwise closely coordinated healthcare. The U.S. system is a $2 trillion industry, staffed by 700,000 doctors, most of them essentially small, independent business people who are generally paid not by their customers, but by insurance companies, according to The Sun.

Meanwhile, other countries are moving ahead. In 2002, the United Kingdom allocated more than $11 billion to computerize its health system. Canada, which began the process a decade ago, is spending $1 billion, and expects to be halfway done by next year. According to a 2006 study, Britain is spending almost $200 per citizen on its e-healthcare system while Canada is putting up more than $30. In the United States, meanwhile, it's less than one dollar, The Sun reported.

Even as U.S health IT adoption lags, several big companies like Microsoft, Google and AOL have their eye on healthcare IT as a lucrative market to enter. These companies see EHRs as huge moneymakers and are now trying to entice consumers to upload and store health information online, which many healthcare IT advocates hope will help spur digitization further.

Michael Barr, vice president of the American College of Physicians, said that the government still has a role to play even as these companies are positioning themselves in the EMR market, according to The Hill.

Uniform standards for sharing medical information still need to be established because healthcare providers are responsible for maintaining complete “medical legal records” for their patients, Barr said. “They’re working on one end of it and not the other,” he said of Google, Microsoft and the other technology companies.

While useful to patients, “these [personal health records] that Microsoft and Google are providing will not replace the medical charts … for documentation purposes,” Barr added.

Concerns about privacy appear to be the main point of contention about the forays into health IT by Google, Microsoft and others because the companies are not covered by HIPAA. All three companies vowed not to sell access to personal health records to drug companies or insurers and allow patients to opt out of having their information shared with other entities.

Even if patients opt out, once they agree on sharing as a condition of using the applications, they have no recourse. Under HIPAA, providers or others who misuse private information can be sanctioned, The Hill reported.
 
In public statements, representatives of Google and Microsoft maintain that their success in offering these records depends on maintaining the trust of their customers, which provides them with a strong incentive to protect their privacy.

Some fear that digital health records, wherever they exist, could end up in the hands of insurance companies, employers, or drug companies - entities that don't always have patients' best interests at heart. While even proponents of computerization agree that limiting access is crucial, most say the problem is not insurmountable.

Those assurances are inadequate to some privacy advocates, including Pam Dixon, executive director of the World Privacy Forum, according The Hill. Dixon said that the healthcare industry’s slow pace to agree on standards for EMRs and invest the money in the systems needed have left the door open to the technology sector to step in and stake a claim to the revenue that can be generated from these applications.

“The healthcare sector is a slow-moving leviathan, but the technology sector is not, and they beat the healthcare sector to the punch,” Dixon said. She added that the issue of privacy protection is moving into “brand-new territory,” given that federal privacy laws do not cover the companies storing medical records.