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BMJ. 2007 November 10; 335(7627): 959.
PMCID: PMC2072045

US government announces electronic health records project

The US federal government has announced the start of a five year project to encourage small and medium sized medical practices to adopt electronic health records. The secretary of state for health and human services, Mike Leavitt, said that the project was designed to show that electronic health records would reduce medical error and improve quality of care.

The project, which is due to start in spring 2008, will involve up to 1200 doctors' practices and as many as 3.6 million patients.

Participating practices will receive an annual bonus for using certified electronic health records to perform specific functions—such as clinical record keeping and prescription ordering—and for meeting certain clinical quality measures. The size of the bonus will depend on how much practices score on a standardised survey that assesses which electronic functions are used to deliver care.

Mr Leavitt said, “By linking higher payment to use of [electronic health records] to meet quality measures, we will encourage adoption of health information technology at the community level, where 60% of patients receive care.”

He said that electronic records would produce major savings over time for Medicare, the federal health insurance programme for elderly people, by improving quality of care. Mr Leavitt added, “This is another step in our ongoing effort to become a smarter purchaser of health care—paying for better, rather than simply paying for more.”

In 2004 President Bush backed the development of a secure, nationwide, health information technology infrastructure that would improve the quality and efficiency of US health care.

But the latest move was sparked by a 2006 report from the Institute of Medicine that found that more than 1.5 million Americans were injured each year through drug errors at hospitals, nursing homes, and doctors' surgeries (www.iom.edu/CMS/2955.aspx, 20 Jul 2006, “Preventing medication errors: quality chasm series”). A study in JAMA (2005;293:565-71) also showed that clinical information was often missing at the point of care but was less likely to be missing in medical practices that used electronic health records.

The Center for Medicare and Medicaid Services, which is running the project, is encouraging private health insurers to offer similar incentives for medical practices to adopt electronic health records.

Only about 10% of doctors in small groups or sole practice use electronic health records, a report from the United Press news agency says (www.Newsday.com, 29 Oct, “US makes new push on e-health records”). Installing such a system costs $20 000 (£9600; €14 000) to $40 000, and doctors may feel that the investment needed would help insurance companies or patients rather more than it would help them, Mr Leavitt is quoted as saying in the report.


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