The trend toward electronic record-keeping in the medical community is "growing," according to the Centers for Disease Control and Prevention (CDC), with one in four physicians now reporting that they make full or partial use of electronic medical records in their office-based practice.

However, many fewer doctors—only one in ten—have adopted what the CDC regards as a fully computerized medical system, consisting of computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes.

That leaves an enormous market for health-related computer systems, when hospitals and clinics—which have been the first to adopt computerized systems so far—and the insurance companies that process claims are added to the list of potential users. In an announcement July 26, computer giant Microsoft appeared to take notice of those market prospects by noting that it will produce clinical health care software to run on its PC computers. That’s a first for Microsoft, which in the past has left it to others to create software for specific applications..

In a move in that new direction, Microsoft has purchased a system developed by a group of Washington, D.C.-based hospitals that is designed to retrieve and quickly display patient information from many sources, including scanned documents, E.K.G.s, X-rays, M.R.I. scans, angiograms, and ultrasound images. In use since 1996, the system, called Ayxxi (pronounced ah-zik-see) is credited with having reduced the time patients must wait in hospital emergency rooms while doctors try to find the medical records needed to treat them. The bottleneck holding up emergency room treatment in the past has been lack of that specific information, said one of the doctors who helped develop the computerized system. "We weren’t doctor-poor or bed-poor," said Dr. Craig Feied. "We were information-poor."

The federal government, meanwhile, is spearheading an initiative to create a computer language to be used by health systems nationwide, which currently employ a wide variety of communication techniques and codes, making it hard or even impossible for one system to provide medical records to another system. In September last year, Secretary of Health and Human Services Mike Leavitt announced formation of the American Heath Information Community, "formed to advance efforts to reach President Bush’s call for most Americans to have electronic health records within the next ten years."

The Community made its first recommendations to Leavitt in May 2006, calling for development of standards to enable "secure messaging" between patients and clinicians, such as e-mail; a secure method of reporting results from laboratory testing; and electronic registration information to replace the medical clipboard.

The Department of Health and Human Services has created an Office of the National Coordinator for Health Information Technology, which convened a first-ever Nationwide Health Information Network Forum in June to talk about the "functional requirements" that have to be met in developing health information networks, including how such a system would retrieve patient records from data sources and repositories while safeguarding security and privacy.

In addition to, and often far ahead of, the government’s health information initiatives are various commercial entities that conduct extensive training for members on such issues as interoperability, privacy, confidentiality, data security, and HIPAA (Health Insurance Portability and Accountability Act) compliance. High on the agendas of such groups are "transactions and code sets," with sections of a forthcoming September conference of the HIPAA Summit, for example, scheduled to consider such topics as "Realizing the National Health IT Strategy through the Adoption of a Standardized Digital Identity Solution." It’s also possible to register for training leading to professional classifications including "Certified Professional in Electronic Health Records" and "Certified Professional in Health Information Technology."

Taking a searching look at electronic health information networks, an article in the June 28, 2006, issue of the Journal of the American Medical Association cautions that while in concept electronic health records will benefit patients, clinicians, and the public, "potentially easy access to large volumes of identifiable health information through interconnected EHR also raises serious concerns about privacy and confidentiality."

Currently, the best protection patients have against inappropriate disclosure of their medical records is how disorganized paper record-keeping tends to be, and how hard it is to trace old records, the report points out. That could change under an electronic system, where access would be more efficiently managed. Noting that decisions about electronic systems will be made at government levels over the next several months, the article urges that privacy-enhancing features should be added to prevent widespread disclosures to third parties.

Information about ongoing federal efforts to develop a health information network is available from the Office of the National Coordinator for Health Information Technology at http://www.hhs.gov/healthit. Information about the American Health Information Community is available at http://www.hhs.gov/healthit/ahic.html.

See also: Is There a Doctor in the Mouse? Ready or Not, IT Is Coming to Health Care, at http://www.healthinschools.org/ejournal/2005/aug2.htm.