Glenda Fauntleroy

WASHINGTON — President Bush, members of Congress, and key consumer organizations are all calling for widespread implementation of electronic personal health records—and now it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, said Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said that various industries and organizations have staked a high level of commitment to making this type of electronic collection commonplace, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM and PepsiCo Inc.

▸ Consumer groups, including AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“This is a very exciting time,” Dr. Lansky said. “Big companies see this year as the time to change how Americans view their health care.”

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular. Most users are those who have both computer skills and a high use of the health care system, with frequent medical appointments or several prescriptions, he said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one national network rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

“This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And they aren't willing to give access to their health information to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” said Dr. Lansky. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough.”

One solution, Dr. Lansky said, is the idea of “consumer access services,” which would play the role of a mediating body to facilitate consumers' access to the network. The mediating body would issue consumers' identity credentials and vouch for them as network users. It would also help consumers aggregate their personal health data and connect with various services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

“Lots of big players are entering this space to help solve these challenges,” said Dr. Lansky. “The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal.”

WASHINGTON — President Bush, members of Congress, and key consumer organizations are all calling for widespread implementation of electronic personal health records—and now it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, said Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said that various industries and organizations have staked a high level of commitment to making this type of electronic collection commonplace, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM and PepsiCo Inc.

▸ Consumer groups, including AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“This is a very exciting time,” Dr. Lansky said. “Big companies see this year as the time to change how Americans view their health care.”

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular. Most users are those who have both computer skills and a high use of the health care system, with frequent medical appointments or several prescriptions, he said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one national network rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

“This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And they aren't willing to give access to their health information to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” said Dr. Lansky. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough.”

One solution, Dr. Lansky said, is the idea of “consumer access services,” which would play the role of a mediating body to facilitate consumers' access to the network. The mediating body would issue consumers' identity credentials and vouch for them as network users. It would also help consumers aggregate their personal health data and connect with various services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

“Lots of big players are entering this space to help solve these challenges,” said Dr. Lansky. “The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal.”

WASHINGTON — President Bush, members of Congress, and key consumer organizations are all calling for widespread implementation of electronic personal health records—and now it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, said Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said that various industries and organizations have staked a high level of commitment to making this type of electronic collection commonplace, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM and PepsiCo Inc.

▸ Consumer groups, including AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“This is a very exciting time,” Dr. Lansky said. “Big companies see this year as the time to change how Americans view their health care.”

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular. Most users are those who have both computer skills and a high use of the health care system, with frequent medical appointments or several prescriptions, he said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one national network rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

“This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And they aren't willing to give access to their health information to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” said Dr. Lansky. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough.”

One solution, Dr. Lansky said, is the idea of “consumer access services,” which would play the role of a mediating body to facilitate consumers' access to the network. The mediating body would issue consumers' identity credentials and vouch for them as network users. It would also help consumers aggregate their personal health data and connect with various services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

“Lots of big players are entering this space to help solve these challenges,” said Dr. Lansky. “The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal.”

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical records system.

“Electronic medical records were a must for me for three reasons,” Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. “Cost was the first because I didn't want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients.”

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer.

He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed, wiping out access to all of his records. It took 6 weeks and about $15,000 to get back up and running.

Four years later, it happened all over again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office to this day. His patients have secure access his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though “I rarely charge [for] them,” he said.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services, improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? “All the performance measures are great,” he said. “But to be honest, I wanted to spend less time in the office and make more money, and I've done that.”

He added, “I used to see about 30 patients per day; now I see about 2 every hour. And my patients are happier because they have more time with their doctor.”

According to Dr. James Morrow, he and his fellow physicians at North Fulton Family Medicine in Cummings, Ga., “didn't go electronic to be better doctors, we did it to survive.”

According to Dr. Morrow, vice president and chief information officer of the North Fulton group, the benefit of their EHR is all about time.

The practice has been able to “save” about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

“At 5:30, the place is a ghost town,” he said. “In the past, at 7:00 p.m. we were still in the office looking for Mrs. Smith's chart. Now we go home at a terrific hour, have dinner with the kids, watch American Idol on TiVo, and then review patient records wirelessly on the laptop.”

The care they're providing at North Fulton has improved as well.

“We can now track quality of care at an outcomes level,” he explained. “We easily track HbA1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals.”

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical records system.

“Electronic medical records were a must for me for three reasons,” Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. “Cost was the first because I didn't want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients.”

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer.

He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed, wiping out access to all of his records. It took 6 weeks and about $15,000 to get back up and running.

Four years later, it happened all over again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office to this day. His patients have secure access his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though “I rarely charge [for] them,” he said.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services, improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? “All the performance measures are great,” he said. “But to be honest, I wanted to spend less time in the office and make more money, and I've done that.”

He added, “I used to see about 30 patients per day; now I see about 2 every hour. And my patients are happier because they have more time with their doctor.”

According to Dr. James Morrow, he and his fellow physicians at North Fulton Family Medicine in Cummings, Ga., “didn't go electronic to be better doctors, we did it to survive.”

According to Dr. Morrow, vice president and chief information officer of the North Fulton group, the benefit of their EHR is all about time.

The practice has been able to “save” about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

“At 5:30, the place is a ghost town,” he said. “In the past, at 7:00 p.m. we were still in the office looking for Mrs. Smith's chart. Now we go home at a terrific hour, have dinner with the kids, watch American Idol on TiVo, and then review patient records wirelessly on the laptop.”

The care they're providing at North Fulton has improved as well.

“We can now track quality of care at an outcomes level,” he explained. “We easily track HbA1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals.”

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical records system.

“Electronic medical records were a must for me for three reasons,” Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. “Cost was the first because I didn't want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients.”

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer.

He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed, wiping out access to all of his records. It took 6 weeks and about $15,000 to get back up and running.

Four years later, it happened all over again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office to this day. His patients have secure access his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though “I rarely charge [for] them,” he said.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services, improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? “All the performance measures are great,” he said. “But to be honest, I wanted to spend less time in the office and make more money, and I've done that.”

He added, “I used to see about 30 patients per day; now I see about 2 every hour. And my patients are happier because they have more time with their doctor.”

According to Dr. James Morrow, he and his fellow physicians at North Fulton Family Medicine in Cummings, Ga., “didn't go electronic to be better doctors, we did it to survive.”

According to Dr. Morrow, vice president and chief information officer of the North Fulton group, the benefit of their EHR is all about time.

The practice has been able to “save” about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

“At 5:30, the place is a ghost town,” he said. “In the past, at 7:00 p.m. we were still in the office looking for Mrs. Smith's chart. Now we go home at a terrific hour, have dinner with the kids, watch American Idol on TiVo, and then review patient records wirelessly on the laptop.”

The care they're providing at North Fulton has improved as well.

“We can now track quality of care at an outcomes level,” he explained. “We easily track HbA1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals.”

WASHINGTON — President Bush, members of Congress, and consumer organizations are calling for widespread implementation of electronic personal health records—and it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital, especially in cases of an emergency.

Health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, explained Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said that various industries and organizations have a high level of commitment to making this type of electronic collection commonplace, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“Big companies see this year as the time to change how Americans view their health care,” Dr. Lansky said.

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular So far, provider portals are used by “only about 15%–20% of the patients to whom they are offered.”

Most users have both computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, according to Dr. Lansky.

One challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one “national network” rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

“This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge may be ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records. They want to know exactly what is going to happen with their health data, and aren't willing to give it to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” said Dr. Lansky. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough.”

One solution, Dr. Lansky said, is the idea of “consumer access services,” which would be a mediating body to facilitate consumers' access to the network. He explained that the mediating body would issue consumers' identity credentials and “vouch” for them as network users. It would also help consumers aggregate personal health data and connect with services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

“Lots of big players are entering this space to help solve these challenges,” said Dr. Lansky. “The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal.”

WASHINGTON — President Bush, members of Congress, and consumer organizations are calling for widespread implementation of electronic personal health records—and it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital, especially in cases of an emergency.

Health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, explained Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said that various industries and organizations have a high level of commitment to making this type of electronic collection commonplace, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“Big companies see this year as the time to change how Americans view their health care,” Dr. Lansky said.

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular So far, provider portals are used by “only about 15%–20% of the patients to whom they are offered.”

Most users have both computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, according to Dr. Lansky.

One challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one “national network” rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

“This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge may be ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records. They want to know exactly what is going to happen with their health data, and aren't willing to give it to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” said Dr. Lansky. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough.”

One solution, Dr. Lansky said, is the idea of “consumer access services,” which would be a mediating body to facilitate consumers' access to the network. He explained that the mediating body would issue consumers' identity credentials and “vouch” for them as network users. It would also help consumers aggregate personal health data and connect with services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

“Lots of big players are entering this space to help solve these challenges,” said Dr. Lansky. “The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal.”

WASHINGTON — President Bush, members of Congress, and consumer organizations are calling for widespread implementation of electronic personal health records—and it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital, especially in cases of an emergency.

Health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, explained Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said that various industries and organizations have a high level of commitment to making this type of electronic collection commonplace, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“Big companies see this year as the time to change how Americans view their health care,” Dr. Lansky said.

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular So far, provider portals are used by “only about 15%–20% of the patients to whom they are offered.”

Most users have both computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, according to Dr. Lansky.

One challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one “national network” rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

“This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge may be ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records. They want to know exactly what is going to happen with their health data, and aren't willing to give it to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” said Dr. Lansky. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough.”

One solution, Dr. Lansky said, is the idea of “consumer access services,” which would be a mediating body to facilitate consumers' access to the network. He explained that the mediating body would issue consumers' identity credentials and “vouch” for them as network users. It would also help consumers aggregate personal health data and connect with services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

“Lots of big players are entering this space to help solve these challenges,” said Dr. Lansky. “The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal.”

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical record system.

“Electronic medical records were a must for me for three reasons,” Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. “Cost was the first because I did not want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients.”

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer. He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed wiping out access. It took 6 weeks and about $15,000 to get back up and running. Four years later, it happened again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office. His patients have secure access to his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though “I rarely charge them,” he said. As part of the online consultation transaction, patients enter a credit card number for the fee; Dr. Heyman said that he only charges the card if he feels he really saved them the time and expense of an office visit.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services and improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? “All the performance measures are great,” he said. “But to be honest, I wanted to spend less time in the office and make more money, and I've done that.” He added, “I used to see about 30 patients per day, now I see about 2 every hour. And my patients are happier because they have more time with their doctor.”

According to Dr. James Morrow, the physicians of North Fulton Family Medicine in Cummings, Ga., “didn't go electronic to be better doctors, we did it to survive.”

Dr. Morrow, vice president and Chief Information Officer of North Fulton, said the benefit of their EHR is all about time. The practice has been able to “save” about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

“We can now track quality of care at an outcomes level,” he explained. “We easily track HbA_1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals.”

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical record system.

“Electronic medical records were a must for me for three reasons,” Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. “Cost was the first because I did not want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients.”

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer. He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed wiping out access. It took 6 weeks and about $15,000 to get back up and running. Four years later, it happened again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office. His patients have secure access to his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though “I rarely charge them,” he said. As part of the online consultation transaction, patients enter a credit card number for the fee; Dr. Heyman said that he only charges the card if he feels he really saved them the time and expense of an office visit.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services and improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? “All the performance measures are great,” he said. “But to be honest, I wanted to spend less time in the office and make more money, and I've done that.” He added, “I used to see about 30 patients per day, now I see about 2 every hour. And my patients are happier because they have more time with their doctor.”

According to Dr. James Morrow, the physicians of North Fulton Family Medicine in Cummings, Ga., “didn't go electronic to be better doctors, we did it to survive.”

Dr. Morrow, vice president and Chief Information Officer of North Fulton, said the benefit of their EHR is all about time. The practice has been able to “save” about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

“We can now track quality of care at an outcomes level,” he explained. “We easily track HbA_1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals.”

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical record system.

“Electronic medical records were a must for me for three reasons,” Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. “Cost was the first because I did not want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients.”

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer. He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed wiping out access. It took 6 weeks and about $15,000 to get back up and running. Four years later, it happened again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office. His patients have secure access to his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though “I rarely charge them,” he said. As part of the online consultation transaction, patients enter a credit card number for the fee; Dr. Heyman said that he only charges the card if he feels he really saved them the time and expense of an office visit.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services and improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? “All the performance measures are great,” he said. “But to be honest, I wanted to spend less time in the office and make more money, and I've done that.” He added, “I used to see about 30 patients per day, now I see about 2 every hour. And my patients are happier because they have more time with their doctor.”

According to Dr. James Morrow, the physicians of North Fulton Family Medicine in Cummings, Ga., “didn't go electronic to be better doctors, we did it to survive.”

Dr. Morrow, vice president and Chief Information Officer of North Fulton, said the benefit of their EHR is all about time. The practice has been able to “save” about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

“We can now track quality of care at an outcomes level,” he explained. “We easily track HbA_1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals.”

WASHINGTON – President Bush, members of Congress, and key consumer organizations are all calling for broad implementation of electronic personal health records–and now it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Now most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, said Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said various industries and organizations have staked a high level of commitment to making this type of electronic collection common, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“This is a very exciting time,” Dr. Lansky said. “Big companies see this year as the time to change how Americans view their health care.”

However, although consumers now can now go many places consumers to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular.

For instance, he reported that so far, provider portals are used by “only about 15%–20% of the patients to whom they are offered.” Most users are those who have computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, Dr. Lansky said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one “national network” rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

Dr. Lansky said it was a good illustration of one way different industries can share data. “This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And consumers are not willing to give access to their health information to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” Dr. Lansky said. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. “But I can say it's going to be tough.”

WASHINGTON – President Bush, members of Congress, and key consumer organizations are all calling for broad implementation of electronic personal health records–and now it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Now most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, said Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said various industries and organizations have staked a high level of commitment to making this type of electronic collection common, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“This is a very exciting time,” Dr. Lansky said. “Big companies see this year as the time to change how Americans view their health care.”

However, although consumers now can now go many places consumers to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular.

For instance, he reported that so far, provider portals are used by “only about 15%–20% of the patients to whom they are offered.” Most users are those who have computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, Dr. Lansky said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one “national network” rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

Dr. Lansky said it was a good illustration of one way different industries can share data. “This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And consumers are not willing to give access to their health information to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” Dr. Lansky said. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. “But I can say it's going to be tough.”

WASHINGTON – President Bush, members of Congress, and key consumer organizations are all calling for broad implementation of electronic personal health records–and now it's time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Now most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, said Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization focused on accelerating the use of information technology in health care and national security.

Dr. Lansky said various industries and organizations have staked a high level of commitment to making this type of electronic collection common, including:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies, such as Microsoft Corp., Google Inc., and WebMD Inc.

“This is a very exciting time,” Dr. Lansky said. “Big companies see this year as the time to change how Americans view their health care.”

However, although consumers now can now go many places consumers to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular.

For instance, he reported that so far, provider portals are used by “only about 15%–20% of the patients to whom they are offered.” Most users are those who have computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, Dr. Lansky said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one “national network” rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

Dr. Lansky said it was a good illustration of one way different industries can share data. “This is an example of where we would like to see the networked personal health record go,” he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And consumers are not willing to give access to their health information to just anyone.

“Each study we've done shows that patients trust their doctor to handle their health record information,” Dr. Lansky said. “The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. “But I can say it's going to be tough.”

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical record system.

"Electronic medical records were a must for me for three reasons," Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. "Cost was the first because I didn't want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients."

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer. He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed, wiping out access to all of his records. It took 6 weeks and about $15,000 to get back up and running. Four years later, it happened all over again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office to this day. His patients have secure access his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though "I rarely charge them," he said.

As part of the online consultation transaction, patients enter a credit card number for the fee; Dr. Heyman said that he only charges the card if he feels he really saved them the time and expense of an office visit.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services and improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? "All the performance measures are great," he commented. "But to be honest, I wanted to spend less time in the office and make more money, and I've done that."

He added, "I used to see about 30 patients per day, now I see about 2 every hour. And my patients are happier because they have more time with their doctor."

According to Dr. James Morrow, the physicians of North Fulton Family Medicine in Cummings, Ga., "didn't go electronic to be better doctors, we did it to survive."

According to Dr. Morrow, vice president and chief information officer of North Fulton, the benefit of their EHR is all about time.

The practice has been able to "save" about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

"At 5:30, the place is a ghost town," he said. "In the past, at 7:00 p.m. we were still in the office looking for Mrs. Smith's chart. Now we go home at a terrific hour, have dinner with the kids, watch American Idol on TiVo, and then review patient records wirelessly on the laptop."

The care they're providing at North Fulton has improved as well.

"We can now track quality of care at an outcomes level," he explained. "We easily track HbA_1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals."

"I'm taking better care of my diabetics," he added. "They're not getting bypasses and amputations like they were before, so the insurance companies' savings are huge, too."

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical record system.

"Electronic medical records were a must for me for three reasons," Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. "Cost was the first because I didn't want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients."

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer. He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed, wiping out access to all of his records. It took 6 weeks and about $15,000 to get back up and running. Four years later, it happened all over again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office to this day. His patients have secure access his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though "I rarely charge them," he said.

As part of the online consultation transaction, patients enter a credit card number for the fee; Dr. Heyman said that he only charges the card if he feels he really saved them the time and expense of an office visit.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services and improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? "All the performance measures are great," he commented. "But to be honest, I wanted to spend less time in the office and make more money, and I've done that."

He added, "I used to see about 30 patients per day, now I see about 2 every hour. And my patients are happier because they have more time with their doctor."

According to Dr. James Morrow, the physicians of North Fulton Family Medicine in Cummings, Ga., "didn't go electronic to be better doctors, we did it to survive."

According to Dr. Morrow, vice president and chief information officer of North Fulton, the benefit of their EHR is all about time.

The practice has been able to "save" about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

"At 5:30, the place is a ghost town," he said. "In the past, at 7:00 p.m. we were still in the office looking for Mrs. Smith's chart. Now we go home at a terrific hour, have dinner with the kids, watch American Idol on TiVo, and then review patient records wirelessly on the laptop."

The care they're providing at North Fulton has improved as well.

"We can now track quality of care at an outcomes level," he explained. "We easily track HbA_1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals."

"I'm taking better care of my diabetics," he added. "They're not getting bypasses and amputations like they were before, so the insurance companies' savings are huge, too."

WASHINGTON — When Dr. Joseph Heyman was starting his small private practice in Massachusetts in 2001, he knew there was no choice but to install an electronic medical record system.

"Electronic medical records were a must for me for three reasons," Dr. Heyman said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence. "Cost was the first because I didn't want to hire a lot of people. Then there was efficiency, to make my job easier, and third was image, because I wanted to seem capable to my patients."

Dr. Heyman, an ob.gyn., started with an initial investment of about $9,000 for two desktop computers, a scanner, and laser printer. He stored all his important information on the computers—patient records, contracts, fee schedules, billing—and things went well until a year later when disaster struck. The system crashed, wiping out access to all of his records. It took 6 weeks and about $15,000 to get back up and running. Four years later, it happened all over again.

Despite two major electronic mishaps in 5 years, Dr. Heyman maintains a paperless office to this day. His patients have secure access his Web site to make appointments as well as view and update their interactive health record. He even offers online consultations for a $15 fee, though "I rarely charge them," he said.

As part of the online consultation transaction, patients enter a credit card number for the fee; Dr. Heyman said that he only charges the card if he feels he really saved them the time and expense of an office visit.

Dr. Heyman said his performance has improved as well: He has eliminated the need for transcription services and improved his coding, and produces error-free legible prescriptions.

And what does he see as the best reward? "All the performance measures are great," he commented. "But to be honest, I wanted to spend less time in the office and make more money, and I've done that."

He added, "I used to see about 30 patients per day, now I see about 2 every hour. And my patients are happier because they have more time with their doctor."

According to Dr. James Morrow, the physicians of North Fulton Family Medicine in Cummings, Ga., "didn't go electronic to be better doctors, we did it to survive."

According to Dr. Morrow, vice president and chief information officer of North Fulton, the benefit of their EHR is all about time.

The practice has been able to "save" about 44 hours per day or about 11,400 billable staff hours per year. He said it's equal to a time savings of more than $239,000 per year (based on 100 patients per day).

"At 5:30, the place is a ghost town," he said. "In the past, at 7:00 p.m. we were still in the office looking for Mrs. Smith's chart. Now we go home at a terrific hour, have dinner with the kids, watch American Idol on TiVo, and then review patient records wirelessly on the laptop."

The care they're providing at North Fulton has improved as well.

"We can now track quality of care at an outcomes level," he explained. "We easily track HbA_1c's, cholesterol, and blood pressure. And we receive reports securely, electronically, legibly, and much quicker from other hospitals."

"I'm taking better care of my diabetics," he added. "They're not getting bypasses and amputations like they were before, so the insurance companies' savings are huge, too."

WASHINGTON — President Bush, members of Congress, and key consumer organizations are all calling for the widespread implementation of electronic personal health records—and now it is time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, explained Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization that is focused on accelerating the use of information technology in health care and national security.

Dr. Lansky mentioned several industries and organizations that have staked a high level of commitment to making this type of electronic collection commonplace:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies such as Microsoft Corp., Google Inc., and WebMD Inc.

"This is a very exciting time," Dr. Lansky said. "Big companies see this year as the time to change how Americans view their health care."

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular.

For instance, he reported that so far, provider portals are used by "only about 15%–20% of the patients to whom they are offered."

Most users are those who have both computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, Dr. Lansky said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one "national network" rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture that the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

Dr. Lansky said it was a good illustration of one way that different industries can share data.

"This is an example of where we would like to see the networked personal health record go," he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And consumers aren't willing to give access to their health information to just anyone.

"Each study we've done shows that patients trust their doctor to handle their health record information," Dr. Lansky pointed out. "The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough."

One solution, Dr. Lansky said, is the idea of "consumer access services," which would play the role of a mediating body to facilitate consumers' access to the network. He explained that the mediating body would issue consumers' identity credentials and "vouch" for them as network users. It would also help consumers aggregate their personal health data and connect with various services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

"Lots of big players are entering this space to help solve these challenges," said Dr. Lansky. "The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal."

WASHINGTON — President Bush, members of Congress, and key consumer organizations are all calling for the widespread implementation of electronic personal health records—and now it is time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, explained Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization that is focused on accelerating the use of information technology in health care and national security.

Dr. Lansky mentioned several industries and organizations that have staked a high level of commitment to making this type of electronic collection commonplace:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies such as Microsoft Corp., Google Inc., and WebMD Inc.

"This is a very exciting time," Dr. Lansky said. "Big companies see this year as the time to change how Americans view their health care."

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular.

For instance, he reported that so far, provider portals are used by "only about 15%–20% of the patients to whom they are offered."

Most users are those who have both computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, Dr. Lansky said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one "national network" rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture that the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

Dr. Lansky said it was a good illustration of one way that different industries can share data.

"This is an example of where we would like to see the networked personal health record go," he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And consumers aren't willing to give access to their health information to just anyone.

"Each study we've done shows that patients trust their doctor to handle their health record information," Dr. Lansky pointed out. "The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough."

One solution, Dr. Lansky said, is the idea of "consumer access services," which would play the role of a mediating body to facilitate consumers' access to the network. He explained that the mediating body would issue consumers' identity credentials and "vouch" for them as network users. It would also help consumers aggregate their personal health data and connect with various services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

"Lots of big players are entering this space to help solve these challenges," said Dr. Lansky. "The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal."

WASHINGTON — President Bush, members of Congress, and key consumer organizations are all calling for the widespread implementation of electronic personal health records—and now it is time to convince the public of their worth, David Lansky, Ph.D., said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Currently, most patients' health information is scattered across many different providers and facilities. Unlike physician- or institution-based electronic medical records, an electronic personal health record is maintained and updated by the patient, and can be vital to providing the patient the best medical care, especially in cases of an emergency.

Information such as health insurance policy numbers, health history, current medications and dosages, and allergies would be quickly accessible and could be shared among hospitals and providers, explained Dr. Lansky, senior director of health programs at the Markle Foundation, a nonprofit organization that is focused on accelerating the use of information technology in health care and national security.

Dr. Lansky mentioned several industries and organizations that have staked a high level of commitment to making this type of electronic collection commonplace:

▸ America's Health Insurance Plans and Blue Cross Blue Shield, whose member plans provide health insurance to more than 100 million Americans.

▸ Large employers, such as IBM Corp. and PepsiCo Inc.

▸ Consumer groups, including the AARP (formerly the American Association of Retired Persons) and the National Health Council.

▸ Internet companies such as Microsoft Corp., Google Inc., and WebMD Inc.

"This is a very exciting time," Dr. Lansky said. "Big companies see this year as the time to change how Americans view their health care."

However, although there are now many places consumers can go to develop an electronic personal health record (such as providers, employers, and pharmacies), they are not extremely popular.

For instance, he reported that so far, provider portals are used by "only about 15%–20% of the patients to whom they are offered."

Most users are those who have both computer skills and a high use of the health care system, with frequent medical appointments or several prescription medications, Dr. Lansky said.

The one great challenge to implementing electronic personal health records nationwide is how to connect all the existing systems into one "national network" rather than what exists now: 13 or so different enterprises, each offering separate portals that aren't linked together.

A possible model, Dr. Lansky said, is a Web site that uses the type of network architecture that the health industry needs to mimic when creating a personal health record network. The site (www.flightstatus.com

Dr. Lansky said it was a good illustration of one way that different industries can share data.

"This is an example of where we would like to see the networked personal health record go," he said.

But the greatest challenge for the industry may be the issue of ensuring consumer privacy. Consumers, Dr. Lansky said, are leery about personal health records because they want to know exactly what is going to happen with their health data. And consumers aren't willing to give access to their health information to just anyone.

"Each study we've done shows that patients trust their doctor to handle their health record information," Dr. Lansky pointed out. "The challenge is to make patients understand that other parties play a role in their health care, and how we get them to expand their trust past their doctor. But I can say it's going to be tough."

One solution, Dr. Lansky said, is the idea of "consumer access services," which would play the role of a mediating body to facilitate consumers' access to the network. He explained that the mediating body would issue consumers' identity credentials and "vouch" for them as network users. It would also help consumers aggregate their personal health data and connect with various services.

Several groups, such as retail pharmacies and health plans, are prepared to offer the consumer access service.

"Lots of big players are entering this space to help solve these challenges," said Dr. Lansky. "The key to success is defining one consumer access service that is trusted by consumers. … This is critical to [our] meeting our goal."

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the U.S. economy, according to Peter Orszag, Ph.D., director of the Congressional Budget Office (CBO).

“In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that,” testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

While the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

In cooperation with several other physician groups, the AMA brought to the hearing a list of recommendations to achieve those goals. In addition to repealing the SGR, the recommendations included having Medicare reimburse physicians for care coordination services that occur outside of a face-to-face visit, and reexamining Medicare's pay-for-performance program.

Dr. Richard Hellman, president of the American Association of Clinical Endocrinologists (AACE), said in an interview that AACE was in agreement with many of the AMA's recommendations. “We think [the pending payment cuts] will decrease access to care,” he said. “Many in Congress seem to be making the calculation that physicians will not leave Medicare, that they will stay in it regardless of what changes in payment policy are made. I think that's a cynical calculation. And the evidence strongly suggests that when physicians are under stress—when they can't earn a living unless they see people more quickly—patient quality of care and safety are put at risk.”

Speaking for himself, Dr. Hellman suggested that Congress needs to reconsider the whole way it looks at Medicare payments. “Currently, if a physician uses his or her skill to prevent a hospitalization or to reduce the number of complications, the rewards go to someone else,” said Dr. Hellman, clinical professor of medicine at the University of Missouri, in Kansas City. “All the government sees is that the physician saw the patient more often or prescribed more medication; it doesn't consider the favorable effect that has on the rest of the system in terms of less nursing home care and less hospital care.

“As long as Congress is paying for hospital care and physician care out of separate buckets, it can never understand that interrelationship and will vainly try to save costs by restricting physician payments,” he continued. “That will only increase quality and safety problems and drive up costs on the other side.”

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is,” testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services.

“Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

Asked by senators what to focus on first, Dr. Wilson responded, “It would be nice if we had the luxury of just having one thing on our plate and one magic bullet, but we don't.”

MedPAC Offers Two Paths: One With Expenditure Targets, One Without

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditure targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of geographically adjusted expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.” Path 2, however, does goes on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the U.S. economy, according to Peter Orszag, Ph.D., director of the Congressional Budget Office (CBO).

“In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that,” testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

While the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

In cooperation with several other physician groups, the AMA brought to the hearing a list of recommendations to achieve those goals. In addition to repealing the SGR, the recommendations included having Medicare reimburse physicians for care coordination services that occur outside of a face-to-face visit, and reexamining Medicare's pay-for-performance program.

Dr. Richard Hellman, president of the American Association of Clinical Endocrinologists (AACE), said in an interview that AACE was in agreement with many of the AMA's recommendations. “We think [the pending payment cuts] will decrease access to care,” he said. “Many in Congress seem to be making the calculation that physicians will not leave Medicare, that they will stay in it regardless of what changes in payment policy are made. I think that's a cynical calculation. And the evidence strongly suggests that when physicians are under stress—when they can't earn a living unless they see people more quickly—patient quality of care and safety are put at risk.”

Speaking for himself, Dr. Hellman suggested that Congress needs to reconsider the whole way it looks at Medicare payments. “Currently, if a physician uses his or her skill to prevent a hospitalization or to reduce the number of complications, the rewards go to someone else,” said Dr. Hellman, clinical professor of medicine at the University of Missouri, in Kansas City. “All the government sees is that the physician saw the patient more often or prescribed more medication; it doesn't consider the favorable effect that has on the rest of the system in terms of less nursing home care and less hospital care.

“As long as Congress is paying for hospital care and physician care out of separate buckets, it can never understand that interrelationship and will vainly try to save costs by restricting physician payments,” he continued. “That will only increase quality and safety problems and drive up costs on the other side.”

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is,” testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services.

“Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

Asked by senators what to focus on first, Dr. Wilson responded, “It would be nice if we had the luxury of just having one thing on our plate and one magic bullet, but we don't.”

MedPAC Offers Two Paths: One With Expenditure Targets, One Without

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditure targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of geographically adjusted expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.” Path 2, however, does goes on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the U.S. economy, according to Peter Orszag, Ph.D., director of the Congressional Budget Office (CBO).

“In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that,” testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

While the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

In cooperation with several other physician groups, the AMA brought to the hearing a list of recommendations to achieve those goals. In addition to repealing the SGR, the recommendations included having Medicare reimburse physicians for care coordination services that occur outside of a face-to-face visit, and reexamining Medicare's pay-for-performance program.

Dr. Richard Hellman, president of the American Association of Clinical Endocrinologists (AACE), said in an interview that AACE was in agreement with many of the AMA's recommendations. “We think [the pending payment cuts] will decrease access to care,” he said. “Many in Congress seem to be making the calculation that physicians will not leave Medicare, that they will stay in it regardless of what changes in payment policy are made. I think that's a cynical calculation. And the evidence strongly suggests that when physicians are under stress—when they can't earn a living unless they see people more quickly—patient quality of care and safety are put at risk.”

Speaking for himself, Dr. Hellman suggested that Congress needs to reconsider the whole way it looks at Medicare payments. “Currently, if a physician uses his or her skill to prevent a hospitalization or to reduce the number of complications, the rewards go to someone else,” said Dr. Hellman, clinical professor of medicine at the University of Missouri, in Kansas City. “All the government sees is that the physician saw the patient more often or prescribed more medication; it doesn't consider the favorable effect that has on the rest of the system in terms of less nursing home care and less hospital care.

“As long as Congress is paying for hospital care and physician care out of separate buckets, it can never understand that interrelationship and will vainly try to save costs by restricting physician payments,” he continued. “That will only increase quality and safety problems and drive up costs on the other side.”

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is,” testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services.

“Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

Asked by senators what to focus on first, Dr. Wilson responded, “It would be nice if we had the luxury of just having one thing on our plate and one magic bullet, but we don't.”

MedPAC Offers Two Paths: One With Expenditure Targets, One Without

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditure targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of geographically adjusted expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.” Path 2, however, does goes on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the economy, according to Peter Orszag, Ph.D., director of the Congressional Budget Office.

“In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that,” testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

Although the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

In cooperation with several other physician groups, the AMA brought to the hearing a list of recommendations to achieve those goals.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is,” testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services. “Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

There are good ideas out there, testified Mr. Hackbarth, but the Centers for Medicare and Medicaid Services is the bottleneck. “We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy,” he testified. The agency doesn't have the staff or information systems to move forward expeditiously.

“We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time,” said Mr. Hackbarth.

Asked by senators what to focus on first, Dr. Wilson responded, “It would be nice if we had the luxury of just having one thing on our plate and one magic bullet, but we don't.”

A Choice of Two Paths: Which One Leads to Better Care?

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. If physicians could see how they use resources, compared with their peers, they would revise their practice styles accordingly, according to MedPAC's report.

The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.” It also recommends that targets should be applied on a geographic basis—applying the most pressure to the parts of the country where there is the highest use of the particular service and the highest contribution to Medicare spending.

Path 2, however, does goes on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the economy, according to Peter Orszag, Ph.D., director of the Congressional Budget Office.

“In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that,” testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

Although the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

In cooperation with several other physician groups, the AMA brought to the hearing a list of recommendations to achieve those goals.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is,” testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services. “Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

There are good ideas out there, testified Mr. Hackbarth, but the Centers for Medicare and Medicaid Services is the bottleneck. “We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy,” he testified. The agency doesn't have the staff or information systems to move forward expeditiously.

“We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time,” said Mr. Hackbarth.

Asked by senators what to focus on first, Dr. Wilson responded, “It would be nice if we had the luxury of just having one thing on our plate and one magic bullet, but we don't.”

A Choice of Two Paths: Which One Leads to Better Care?

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. If physicians could see how they use resources, compared with their peers, they would revise their practice styles accordingly, according to MedPAC's report.

The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.” It also recommends that targets should be applied on a geographic basis—applying the most pressure to the parts of the country where there is the highest use of the particular service and the highest contribution to Medicare spending.

Path 2, however, does goes on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the economy, according to Peter Orszag, Ph.D., director of the Congressional Budget Office.

“In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that,” testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

Although the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

In cooperation with several other physician groups, the AMA brought to the hearing a list of recommendations to achieve those goals.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is,” testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services. “Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

There are good ideas out there, testified Mr. Hackbarth, but the Centers for Medicare and Medicaid Services is the bottleneck. “We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy,” he testified. The agency doesn't have the staff or information systems to move forward expeditiously.

“We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time,” said Mr. Hackbarth.

Asked by senators what to focus on first, Dr. Wilson responded, “It would be nice if we had the luxury of just having one thing on our plate and one magic bullet, but we don't.”

A Choice of Two Paths: Which One Leads to Better Care?

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. If physicians could see how they use resources, compared with their peers, they would revise their practice styles accordingly, according to MedPAC's report.

The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.” It also recommends that targets should be applied on a geographic basis—applying the most pressure to the parts of the country where there is the highest use of the particular service and the highest contribution to Medicare spending.

Path 2, however, does goes on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

Peter Orszag, Ph.D., director of the Congressional Budget Office, testified that “in health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that.”

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

Commissioners were unable to forge a consensus on what should be done to replace the sustainable growth rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified. Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does. (See box.)

Eliminating spending targets would require Congress to create a whole new system with incentives to physicians to provide high-quality, low-cost care, Mr. Hackbarth said. Keeping targets would simplify payment reform but still would require changes to make the system more equitable.

About spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” Doctors account for a small portion of increasing premiums, but they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The Congressional Budget Office has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years,” Dr. Orszag testified. “Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

There are good ideas out there, Mr. Hackbarth testified, but the Centers for Medicare and Medicaid Services is the bottleneck. “We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy,” he testified. The agency doesn't have the staff or information systems to move forward expeditiously.

“We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time,” Mr. Hackbarth said.

Which Path Leads To Better Care?

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth said that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system.

The commissioners couldn't agree on just one solution, he said, so they offered two proposals, deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures

▸ Ensuring accurate prices by identifying and correcting mispriced services

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country.

The commission proposes that Medicare use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also includes a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.”

Path 2 proposes that expenditure targets be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

Peter Orszag, Ph.D., director of the Congressional Budget Office, testified that “in health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that.”

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

Commissioners were unable to forge a consensus on what should be done to replace the sustainable growth rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified. Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does. (See box.)

Eliminating spending targets would require Congress to create a whole new system with incentives to physicians to provide high-quality, low-cost care, Mr. Hackbarth said. Keeping targets would simplify payment reform but still would require changes to make the system more equitable.

About spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” Doctors account for a small portion of increasing premiums, but they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The Congressional Budget Office has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years,” Dr. Orszag testified. “Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

There are good ideas out there, Mr. Hackbarth testified, but the Centers for Medicare and Medicaid Services is the bottleneck. “We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy,” he testified. The agency doesn't have the staff or information systems to move forward expeditiously.

“We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time,” Mr. Hackbarth said.

Which Path Leads To Better Care?

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth said that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system.

The commissioners couldn't agree on just one solution, he said, so they offered two proposals, deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures

▸ Ensuring accurate prices by identifying and correcting mispriced services

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country.

The commission proposes that Medicare use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also includes a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.”

Path 2 proposes that expenditure targets be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

“We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier,” said Dr. Cecil Wilson, board of trustees chairman for the American Medical Association.

Peter Orszag, Ph.D., director of the Congressional Budget Office, testified that “in health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that.”

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

Commissioners were unable to forge a consensus on what should be done to replace the sustainable growth rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified. Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does. (See box.)

Eliminating spending targets would require Congress to create a whole new system with incentives to physicians to provide high-quality, low-cost care, Mr. Hackbarth said. Keeping targets would simplify payment reform but still would require changes to make the system more equitable.

About spending targets, Dr. Wilson said, “No amount of tinkering can fix what is broken beyond repair.” Doctors account for a small portion of increasing premiums, but they are the only group that has spending targets imposed on them, he added.

“The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services,” he said.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The Congressional Budget Office has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

“There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years,” Dr. Orszag testified. “Given the scale of the problems that we face, we need to be trying lots of different things and recalibrating all the time,” he said.

There are good ideas out there, Mr. Hackbarth testified, but the Centers for Medicare and Medicaid Services is the bottleneck. “We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy,” he testified. The agency doesn't have the staff or information systems to move forward expeditiously.

“We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time,” Mr. Hackbarth said.

Which Path Leads To Better Care?

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth said that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system.

The commissioners couldn't agree on just one solution, he said, so they offered two proposals, deemed “Path 1” and “Path 2.”

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures

▸ Ensuring accurate prices by identifying and correcting mispriced services

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country.

The commission proposes that Medicare use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also includes a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put “financial pressure on providers to change.”

Path 2 proposes that expenditure targets be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.