Electronic Medical Records and Obama’s Economic Plan

On Dec. 6, President-elect Obama announced the
three major pillars of his economic recovery plan: rebuild our
roads/bridges, enhance our schools including broadband, and deploy
electronic health records for every clinician and hospital in the U.S.

I can summarize all my advice to the new administration in one sentence: Allocate
Federal funds of $50,000 per clinician to states, which will be held
accountable (use it or lose it) for rapid, successful implementation of
interoperable CCHIT certified electronic records with built in decision
support, clinical data exchange, and quality reporting.

Not only
will this improve care coordination which will lead to better
health care value (reduced cost, enhanced quality), it will create jobs.

Just how many jobs would this create? For just the Beth Israel Deaconess Community Clinician project, here’s the list of jobs we created:

2009, we will implement 150 physicians in 75 practices, or 13
physicians in 6 practices per month. The direct staff we’ll need are:

Massachusetts eHealth Collaborative:  6 FTEs (5 practice consultants plus a project manager)

Concordant:  9 FTEs (5 on-site assessment/design/deployment/support, 2 technical lead/system architect, 2 project management)

eClinicalWorks:  4 FTEs (3 on-site trainers, plus part of a product specialist and a project manager)

At BIDMC, the project is run by 3 FTEs (Project Director, Technical Lead, Senior Practice Consultant)

we’ve created 22 jobs for the rollout and support of our EHR project.
Multiply this by the number of clinicians needing EHRs in the country
and you’ll see that the Obama plan will create tens of thousands of new
high tech jobs.

When I’ve discussed the Obama Economic plan with
my colleagues, some have said that it’s too early to invest in EHRs
because they are not yet standards-based or fully interoperable. I
believe that commercial EHRs are good enough and as of 2008, we have
many real examples of data sharing. Here are the statistics from our
work in Massachusetts that includes homegrown EHRs, eClinicalWorks, GE
Centricity, Next Gen, Allscripts/Misys, and Epic.

2008, we’ve done 60 million data exchange transactions a year from
EHRs, practices management systems, and hospital information systems.

– We’ve done half a million e-prescribing transactions among providers,
payers and pharmacies. Every discharge from the hospital and emergency
department at BIDMC generates a standards-based clinical summary which
is sent electronically to PCPs and referring clinicians. In 2009, we’ll
expand this to include referral workflow, community to community
exchange, and several additional hospitals including Children’s.

eHealth Collaborative – We’ve wired three communities (Brockton,
Newburyport, North Adams) with roughly 500,000 patients, 597 physicians
in 142 practices in 192 sites, and 4 hospitals including hospital-based
laboratories and imaging centers. North Adams went live in May 2007,
Newburyport went live in September 2008, and Brockton is 40% complete.
Data exchange includes problem lists, procedures, allergies,
medications, demographics, smoking status, diagnoses, lab results and
radiology results. Standards used include HL7 2.6, Continuity of Care
Record/Document, NCPDP Script 8.1, LOINC, CPT4, ICD9, and RxNorm. Over
90% of patients have opted in for community data sharing. Over 300,000
records have been exchanged, all from existing commercial EHRs.

Thus, the EHRs are ready, the standards are harmonized, the architecture is
designed, and the only barrier is political. The Obama commitment to a
nationwide EHR implementation effort means that 2009 is the tipping
point. Let us band together, payer, provider, employer and patient, to
make it happen!

See also: I’ve written several recent blogs about the cost of electronic health records, the state of interoperability, and my predictions for the early healthcare IT activities of the Obama administration.

John D. Halamka, MD, MS, is CIO of the
CareGroup Health System, CIO and Dean for
Technology at Harvard Medical School, Chairman of the New England
Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US
Healthcare Information Technology Standards Panel (HITSP), and a
practicing emergency physician. He blogs regularly at Life as a Healthcare CEO, where this post first appeared.

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squirting mastery videosAllscriptsjeff kortePresentation boardalex Recent comment authors
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squirting mastery videos

Amazing issues here. I’m very glad to see your post. Thanks so much and I am having a look ahead to contact you. Will you kindly drop me a e-mail?


The President made health care a centerpiece of his campaign, including investments in health care-related information technology

jeff korte
jeff korte

The nurses always find most needed information when the patient is admitted. I always squish my joints back properly.

Presentation board

I think the FOSS paradigm works superbly. It should be used in this case.


Alex Papas, has been credited for creating and developing the prepaid phone card in the United States. He has now again created and developed another great product for everyone. It’s called the MedeFile Card. MedeFile’s centralized, confidential electronic portfolio gives everyone 24/7 access to there medical history. No more wasting time and filling out paperwork when you go to the doctor or the hospital. All Medefile Card members get a free MedeDrive (a small usb drive) that fits on your key chain, so now, just hand your MedeDrive to the receptionist its that simple…

Doctor in Washington State
Doctor in Washington State

Sorry … that’s loss OF provider productivity. This means we are seeing fewer patients and providing less services to our patients because the computer takes up so much of our time.

Doctor in Washington State
Doctor in Washington State

We have been using Centricity EMR in our community clinic for a year and a half now and we are losing money like crazy due to loss or provider productivity. I am a physician in the practice. I can understand that EMR will someday have the potential to improve patient safety and prevent errors, but the software has not reached that level of sophistication yet. There are many, many inefficiencies in Centricity. I could bore you all with examples, so I will choose one – The ‘red alert’ for drug interactions. This system failed to alert a prescriber who wrote… Read more »

Wendell Murray

“…Federal funds of $50,000 per clinician to states” Terrible idea, although I think that the faster clinical data is digitized on a regular basis the better. Tax-payer funds at that level introduced into the medical services business will be almost completely “wasted” in the sense that the alternative is to spend next to no funds (i.e. tens of millions at most) on establishment of an Apache Software Foundation or comparable entity-sponsored open source project to enhance a given existing EMR/PM product openEMR for example. The FOSS paradigm works superbly. It should be used in this case. The same or a… Read more »


I do NOT want to be in a national data base so I guess I am DONE with doctors!

William C
William C

As both a retired clinician who has used EMR and as a patient who has been victim of many clinicians who use the EMR (through the VA Healthcare system) EMR is a tool. Good, well trained clinicians will find it a valuable tool and improve care through its use. Clinicians with marginal ability and caring will use it as either a crutch, using only prompts to do clinical interventions or blaming the EMR for their lack of ability. Clinicians who never read a paper chart will not read an EMR, those with poor paper notes will have poor electronic notes.… Read more »


While an efficient and interoperable EMR will cut costs and improve efficiency in obtaining information and reduce errors I doubt it will end up saving money from a societal perspective. Will the gvt go on funding IT support forever? Who will the cost burden fall on when they stop? Will the cost savings really outweigh the implementation and ongoing IT expense? Will this massive infusion of money run up costs and stoke inflation, eroding the value of the dollar for patients and physicians. Show me the data scientists. Even if these efficiencies do save money will they make a dent… Read more »


Hey guys – for those of you interested in learning more about electronic medical records, specifically relating to ophthalmology, you might want to check out this fun and informative blog that was created by IO Practiceware (a company that makes EMR and practice management software):
I haven’t really seen anything like it — go on and give it a look.


“it was with a near complete sense of certitude” – I think you hit the nail on the head. I do think most of us have to eat more humble pie, both physicians and patients. Some physicians think they know everything, and some patients think they can self diagnose or treat themselves better with what they read on the internet (of course some of them are right, but this is rather the exception than the rule). Both is often unproductive and at times harmful (I am not talking about networking re. diagnosed conditions or doing research to find a good… Read more »

Jane Jacobs

There are so many factors involved in quality health care, and there is no one solution — including Health IT. Health IT is merely a tool — albeit a powerful one — and I would never claim it is the sole solution. In the end, good communication and trust between a patient and a provider or group of providers is the key. The patient has to become a full partner in their health care to the best of their ability. Will everyone do it well or even be interested in doing it? Of course not. But we must recognize that… Read more »

Christine Gray
Christine Gray

I apologize for my incivility. Whenever anyone almost accidentally killed my daughter, it was with a near complete sense of certitude. She was virtually the 100th diagnostic possiblity out of 100. Navigating a referral without records in hand is like driving a car blind. I spent three hours doing it today, with roughly a 50% success rate. If I didn’t know the CEO of the local hospital, the process of clarification on this particular issue would be double the time, six months instead of three. In the hypothetical MRI/MS case you mention, participatory medicine would ideally recount patient misinterpretation/naivete as… Read more »