Computerized medical records: stimulus or socialism?

WASHINGTON — The $787 billion economic stimulus legislation includes $19 billion to modernize health care information technology systems, a move that's intended to lead to the computerization of all Americans' medical records by 2014.

Is that $19 billion intended to create much-needed jobs and fix a health care system that's choking on paper? Or is it a stealthy opening move toward national health care?

Many economists and health care experts say the plan is worthy of stimulus money because it will create tens of thousands of jobs in information technology, informatics (the managing and processing of data and information) and other computer-related industries, and will also lower health care costs and improve efficiency by reducing medical paperwork.

Don Detmer, the president of the American Medical Informatics Association, estimates that it will take a small army — some 130,000 information technicians and 70,000 informatics specialists — to achieve President Barack Obama's goal of computerizing everyone's medical records within five years.

"There's a quite a lot of long-term and short-term job potential," Detmer said. "You need people who know how to implement these things and make major changes. You just don't buy it, plug it in, and live happily ever after."

However, Robert Moffit, the director of the Center for Health Policy at the Heritage Foundation, a conservative think tank, said that the provision is nothing more than a Trojan horse for the Obama White House's true aim — transforming the nation's health care policy with as little public debate as possible.

"He's sticking big chunks of his health care package into the stimulus plan," Moffit said. "It's a terrible way for a democratic republic to operate. None of these provisions have been subject to any kind of congressional consideration — no committee mark-up, no debate on the floor, just buried into the bill."

Congressional Republicans and conservatives have seized on those criticisms to accuse the Obama administration of heading toward a European-style health care system with rationed medical care. They spotlight both the health information technology provision and another $1.1 billion for comparative effectiveness research — studying which treatments work better than others — to argue their case.

"Congressional Democrats are using the cover of an economic crisis to advance an agenda that will destroy the doctor-patient relationship and set us on a course for government-administered health care," Rep. Tom Price, R-Ga., the chairman of the Republican Study Committee, said Friday.

Conservative talk radio host Rush Limbaugh has joined the bandwagon, surmising on the air that Obama had gotten advice to hide details of his health care plan in the stimulus bill from former Sen. Tom Daschle, D-S.D, who withdrew earlier this month from consideration to be the president's Health and Human Services secretary.

"Daschle advised Obama, 'Stick it in here because the way the Clintons tried it will fail,' " Limbaugh said. " 'They went big. They went all in. It allowed for people to oppose it and tear it apart. Do it stealthily.' "

Supporters of the health provisions wasted no time responding.

The American Medical Association said that the provisions wouldn't "create a federal system for electronically tracking patients' medical treatments or for monitoring compliance with federal treatment standards."

White House Press Secretary Robert Gibbs said Friday that the GOP complaints were simply political rhetoric. He said it's "exceedingly similar to what we've heard for — going on the last two decades."

"We have to move our health care system into the 21st Century," Gibbs said. "If I was for saving small businesses money on their health care," as Republicans claim to be, "I'd be for an increased investment in health care I.T."

Not all Republicans are unhappy with the measures, either.

David Merritt, project director the Center for Health Transformation, a group founded by former House Speaker Newt Gingrich, R-Ga., said the health technology provision is a job-creator and is needed to rescue the nation's health care system.

"The Bush administration is the one that teed all this up, working on IT for five years, and he (Bush) mentioned it in the State of the Union address four times," said Merritt, who edited the book "Paper Kills: Transforming Health and Healthcare with Information Technology."

"The Obama administration is picking up where Bush left off," Merritt said.

Mark McClellan, Bush's former commissioner for the Centers on Medicare and Medicaid Services, is also bullish on the health care technology provision, though he questions how quickly the measure will produce jobs.

"Most of the spending isn't going to happen right away," said McClellan, now a fellow at The Brookings Institution, a center-left think tank. "There's still a lot of work to be done before this money can be used effectively."

Still, Dr. William Hersh, the chair of the Department of Medical Informatics & Clinical Epidemiology at Oregon Health & Science University's School of Medicine, thinks the stimulus money will be a sizable help in hiring info-tech specialists and retraining health care professionals who now keep paper records.

Dr. Hersh authored a study last year that said it would take at least 40,000 info- technologists to help the nation's hospitals alone shift from paper to computerized record keeping.

He and other health care experts say they understand the debate over whether some of the stimulus plan's health provisions should have been in a stand-alone health care bill. But the argument is of little value to him.

"If we had a political process that could prioritize things, maybe it would have been better to do it in a health care reform bill," he said. "But if it's a choice between doing it in the stimulus package or not at all, I'll take the stimulus package."


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