Steve Findlay, managing editor
Consumer Reports Best Buy Drugs

As health-care innovators met this week in Seattle, much of the debate was expected to focus on the value of electronic health records. At issue: Will transforming those silly, color-coded paper files that contain our medical histories into a computerized version really save us money?

The short answer is yes. But it's still not exactly clear how we get there, or how long it will take. Only about 5 percent of doctors have computer-based electronic health records systems now.

EHRs (as they’re called) will undoubtedly improve quality of care. The clinical benefits of having a patient's records at a click of a mouse are undeniable, but they may be incremental at first – better preventative care reminders, drug interactions, etc. And for an individual doctor, transferring to an EHR system is a costly upfront expense; it can take years to recoup the cost in efficiency gains and financial savings.

But simply having EHR software in individual doctors' offices unlinked to a wider “interoperable” national information system is not where we need to go. Sure, that's a nice tool for docs and their staffs. The real transformative power to our health care system, however, lies in EHRs that are linked in to a national electronic health information network or grid, working on the Internet. And that will happen only when as a nation finally we nail down the standards, make the necessary investment in a secure, encrypted system, and, over time, mandate its use for the transfer of patient information where and when it's needed.

That information needs to be able to move to the local hospital, but also across state lines, to providers across the country, and even someday internationally. And data on patient care and quality needs to be able to be extracted from EHRs in a way that protects patient privacy absolutely but permits research to help identify what works and doesn’t in medicine.

I would go so far as to say that the power of such a system to change the way health care is delivered, and to change patient care itself, is not yet fully comprehended. We are just too far away and can’t really imagine how it's going to look and feel.

There are some hints from the experience in EU countries – with dramatically improved coordination of care among docs and hospitals. But bear in mind they are early in the game. Our own Veterans Affairs department, which has had electronic records for its 5 million patients since 1999, scored higher in overall quality of care, chronic disease care and preventive care in one study than non-VA patients without EHRs.

On the money and savings point so often raised in this debate – EHRs and a formal National Health Information Network (the elusive NHIN) will no doubt produce savings. The savings estimates range from an amazing $80 billion to $160 billion annually -- from shorter hospital stays through coordinated care, better prevention of serious illness, less medical staff time doing admin work, reduced prescription errors, etc, etc.

But the costs these new tools generate in additional needed care, research and other applications, especially in a newly universal coverage system, will also add to cost -- so the jury is still out on the exact savings. And we may never be able to isolate those cleanly, because the health system we (hopefully) start to develop over the next five to 10 years will be greatly altered by the enhanced flow of electronic information and data.

With luck and the right investments, a national electronic health information network will give us real tangible benefits, in quality of care and dollars saved. It will feel as different as working on a computer hooked to the Internet today compared to working on a 1980s Kaypro.

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