Work Begins on National E-Health Record Network

KANSAS CITY, Mo. -- Dr. James E. Sanders is a big believer of switching patient records from old paper files to sophisticated computer databases.

The electronic medical records system at the Department of Veterans Affairs' Kansas City Medical Center gives Sanders and his staff almost immediate access to medical histories, allowing them to seamlessly treat veterans from other states. But when patients aren't in the VA's system, it could mean hours or days before doctors have crucial information to properly care for patients.

"It's increasingly frustrating for us and other providers that it's difficult to find a workable interface," said Sanders, chief of staff for the Kansas City veterans hospital. "Our systems don't talk to each other."

Interoperability, or allowing providers to share records and view them from anywhere, is a requirement for facilities to receive some of the more than $17 billion in stimulus funding that the government is offering to encourage the adoption of electronic medical records. Congress will likely penalize providers who aren't doing so by 2014, cutting their Medicaid and Medicare payments, the Obama administration said.

But the debate over interoperability among health care providers, which has been going on for years, could take well beyond the 2014 timeframe to be solved, industry experts say.

"A private sector effort started 11 years ago and is still a going concern," said Carla Smith, executive vice president of the Healthcare Information and Management Systems Society. "Every year they solve an X number of problems. They're eating the elephant one bite at a time."

For an integrated system to work, developers at different companies have to agree on how their hundreds of programs uniformly present information and connect with each other. For example, if one uses its own set of abbreviations, the information would be useless to a doctor who uses a different program.

As opposed to a "national" system, some envision a "network of networks" that would resemble the model used in the banking industry for customers to access their accounts through ATMs nationwide.

Studies have found that less than 10 percent of U.S. health care providers are using electronic medical records.