David Blumenthal: The TT Interview

Dr. David Blumenthal, the national coordinator of Health Information Technology, is responsible for doling out some $100 million in grants to help Texas doctors transition to electronic medical records by 2014. Last week, he was the keynote speaker at a conference in Austin on the impact of e-records, and he toured a clinical simulation that trains University of Texas graduates to become specialists in health information technology. Later, he sat down with the Tribune to talk about protecting patient privacy during the transition, making that switch easier for doctors and how Texas patients will fair when hospitals and doctors' offices — finally — go paperless.

TT: Medical records are slated to go paperless by 2014. How important is it for patients to have their records in electronic form?

Blumenthal: I think most patients will see that there are a lot of advantages to getting their records into digital forms. For example, having information present in an emergency room if their doctors’ offices are closed, or if they can’t get a hold of them or don’t remember where they were seen. As well as the simple things, like getting rid of all those clipboards that people are always filling out when they go and see physicians. So I think there are big, big benefits. What we have to do is to just assure people that we’re going to do everything possible to make sure that their information is kept as private or more private as it is in the paper form.

TT: The issue of privacy has been a hotbed of concern. There have been reports, even here in Texas, of patient electronic records being sold to research companies. How do you respond to concerns that electronic records will only increase the risk of violating patient privacy? 

Blumenthal: Well, they shouldn’t be sold if people don’t give consent. We’re committed to having patients control the uses of their health data. Their consent is going to be vital.

TT: Whose responsibility is it to ensure that patient privacy is protected?

Blumenthal: It’s a collective responsibility. We, in the federal government, give our best judgment about what the preferred approach is to getting patient consent. I think we also need to enforce the existing laws that penalize people who don’t carefully guard patient information, and there are substantial penalties available. States have a responsibility because they have a lot of freedom to set local laws to make sure that they involve the public in creating those statutes and those regulations. Doctors and hospitals have to understand what patients want and need from them in the way of privacy in the electronic world.

TT: There is a range of physicians’ opinions concerning the implementation of electronic medical records. Some younger physicians say it simplifies their job, while older physicians, especially those reaching retirement, see this transition as an added burden and expense. But I also understand that physicians can receive up to $64,000 in incentives to make the transition. How do you respond to such wide-ranging views?

Blumenthal: We’re trying to respond to physicians and other health care providers where they are. For people who are on the verge of retirement, there’s obviously a tough decision to make about whether they want to make this transition now. I think it will add to the value of their practice. It will make it easier for them to replace themselves with a young physician, so if they want to continue to care for their patients and make sure that their patients have a physician or a nurse to follow in their footsteps, having an office that is already electronic will be a big asset. For the physician who is a little bit younger, who may have 10, 15 or 20 years of practice left, I think the facts are clear that this is an inevitable change. The federal government’s willing to help now, but it won’t be in five or seven years. There is never going to be another opportunity to get up to $64,000 from the federal government for doing something that is inevitable. It’s a once-in-a-lifetime — once-in-a-career — opportunity. If you know you have to do it, you don’t want to be in practice 10 years from now and be the only one in the community that doesn’t use electronic records for collecting information.

TT: As a physician, you know doctors are constantly learning and using new medical technology. Aren’t electronic medical records just another form of technology that they have to learn?

Blumenthal: It’s different. The difference is that it’s more part of their routine work. And it requires more in the way of changing the way they think and the way they organize their personal office. This is true for physicians who are in small practices. For physicians who are part of big organizations, a lot of things can be done to help them make the transition, and it’s happening all the time. A lot of doctors are joining big organizations because they get the help they need to make the transition without much disruption. There is nothing more intimate or personal about a physician’s practice than the way they record information. To change that is a big personal change.

TT: Based on your recent trips to Texas, how is the state faring with implementation?

Blumenthal: There are areas of great progress and of great opportunity. A couple weeks ago, I was at Ben Taub Hospital in Houston. They’ve basically gone electronic, and they’re incredibly proud of it. They’ve changed a whole lot of things about the way they do their work. They’ve improved quality and convenience for their patients. A lot of these big hospitals in Texas are way out in front and doing extremely well. Texas is an incredibly diverse state, and that diversity mirrors the United States.

TT: Are rural areas of Texas facing more challenges with implementation?

Blumenthal: There are really small critical access hospitals that are totally electronic, so there’s nothing about being rural that makes it impossible. It’s just that it’s a little slower to happen. I think practices in rural areas tend to be smaller. They tend to be less well-compensated, so their resources aren’t as large. The small hospitals don’t have big staffs or IT staffs. In a lot of areas, it’s a hospital that helps the local physicians to make that transition and some rural areas don’t have those kinds of advantages. And finally, some places just don’t have broadband internet.