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Obama Touts Military Digital Health Record Plan as Model

April 9, 2009 at 6:15 PM EDT
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A new electronic medical records system for military personnel is meant to be a model for improving health care nationwide. Analysts discuss the program's cost and efficiency.

ANNOUNCER: The president of the United States…

RAY SUAREZ: Flanked by Defense Secretary Robert Gates and Veterans Affairs Secretary Eric Shinseki, President Obama today announced a new health records plan for the nation’s military and its veterans.

BARACK OBAMA, President of the United States: Too many wounded warriors go without the care that they need. Too many veterans don’t receive the support that they’ve earned. It’s time to change all that; it’s time to give our veterans a 21st-century V.A.

Under the leadership of Secretary Gates and Secretary Shinseki, the Department of Defense and the Department of Veterans Affairs have taken a first step towards creating one unified lifetime electronic health record for members of our Armed Services that will contain their administrative and medical information from the day they first enlist to the day that they are laid to rest.

RAY SUAREZ: The president said the more efficient system would prevent health care delays currently experienced by wounded veterans; 33,000 men and women have been injured in the ongoing wars in Iraq and Afghanistan.

Veterans now face a six-month backlog when filing disability claims at the Veterans Administration.

BARACK OBAMA: Currently, there is no comprehensive system in place that allows for a streamlined transition of health records between DOD and the V.A., and that results in extraordinary hardship for an awful lot of veterans who end up finding their records lost, unable to get their benefits processed in a timely fashion.

And that’s why I’m asking both departments to work together to define and build a seamless system of integration with a simple goal: When a member of the Armed Forces separates from the military, he or she will no longer have to walk paperwork from a DOD duty station to a local V.A. health center. Their electronic records will transition along with them and remain with them forever.

RAY SUAREZ: The president has made it clear he wants to make electronic records a cornerstone of his national health care reform. A recent study showed fewer than 2 percent of U.S. hospitals have adopted comprehensive electronic record systems.

The Pentagon and Veterans Affairs systems could serve as a model. Of the more than 23 million veterans in the United States, nearly 5.5 million sought health care at a V.A. facility last year.

BARACK OBAMA: Now, this would represent a huge step towards modernizing the way health care is delivered and benefits are administered for our nation’s veterans. It would cut through red tape and reduce the number of administrative mistakes. It would allow all V.A. sites access to a veteran’s complete military medical record, giving them the information they need to deliver high-quality care.

RAY SUAREZ: The president also said today his budget would increase funding for improving overall health for military personnel. That includes additional money for mental health screening in rural parts of the country and for more treatment for service people suffering from traumatic brain injuries.

The White House plans to expand spending on Veterans Affairs by $25 billion over the next five years, pending approval from Congress.

Cutting down on backlog

Steve Robinson
Veterans for Common Sense
[W]e applaud the electronic medical record. It's been a battle of over seven years to get this thing finally announced by a sitting president.

RAY SUAREZ: We get some perspective now on today's announcement and how this initiative fits into a broader push for more electronic records in the health care system.

It comes from Steve Robinson with Veterans for Common Sense, a veterans advocacy organization. He had a 20-year career in the Army and retired as a senior noncommissioned officer.

Dr. Donald Berwick, president and CEO of the Institute for Healthcare Improvement, an independent, not-for-profit group working on patient care issues.

And Dr. Deborah Peel, founder and chair of the Patient Privacy Rights Center, a health privacy watchdog group. She joins us from Albany.

Welcome, guests. Let me begin by asking you all what the Obama announcement today, the Obama administration's announcement today, addresses about what's wrong with the medical health care system.

Steve Robinson?

STEVE ROBINSON, Veterans for Common Sense: Well, we applaud the electronic medical record. It's been a battle of over seven years to get this thing finally announced by a sitting president.

One of the biggest problems veterans have in the V.A. is providing the evidence that they were injured on the battlefield or what kinds of diagnoses they have, and so this medical record is going to create a situation where the DOD is going to be responsible for collecting that information.

Putting it in electronic medical records, sharing it immediately with the V.A. should cut down the backlog. That's one of the most important things that came out of this.

But there are other issues that need to be addressed. The head of the snake is making sure that the Department of Defense correctly makes diagnoses with people before they send them to the V.A. If a veteran doesn't get the correct diagnosis with this new electronic medical record, then they're going to have problems getting into the V.A. health care system.

RAY SUAREZ: Dr. Berwick?

DR. DONALD BERWICK, CEO, Institute for Healthcare Improvement: I think it's a wonderful turn of events, rather thrilling, actually. Here are two very large systems agreeing to cooperate and using seamless information transfer to get something done for people that we owe that to and that are quite vulnerable.

We know that defects in care for veterans, returning warfighters happen at handoffs. So this is very good for a very important population.

It's also good for the country, because this can be an example of how we can use electronic platforms and better information management to make care seamless for all Americans who need that, especially chronically ill people who are also vulnerable to drop balls.


DR. DEBORAH PEEL, Patient Privacy Rights: We're very excited about electronic health care records. And I think the point about the need to be able to move them where you want them when you want them to the right person is critical. And the whole system in America needs to have the same ability to interoperate and move records where the patients want them.

Our concern at Patient Privacy Rights is not just getting the right records to the right person, but ensuring that our sensitive medical records aren't used for all kinds of purposes that have to do with discrimination, such as in employment, insurance, educational opportunities, and the rest.

And today, our medical health care system that's electronic has been leaking records everywhere. So we want the benefits, but we want to prevent the harms at the same time.

Security of record systems

Dr. Deborah Peel
Patient Privacy Rights Center
[W]e think that Congress and the new president are moving in the right direction to make sure that we have an ethical, trustworthy system.

RAY SUAREZ: Well, Dr. Peel, when you hear the president talk about, as he did today, one unified lifetime health record, what kind of cautions would you want to point out both to military people and to the civilian population?

DR. DEBORAH PEEL: Well, any time there's easy access to electronic records, we get both benefits and tremendous risks. So some of the big risks are, how secure are the systems? In other words, how easy is it to break into the systems for people to steal information or lose it on a laptop? So security is a big issue both for the military and for all of the rest of us.

The other issue is, who controls access to records? For over 200 years in this nation, it's been you, the patient, making the decision who sees your record.

But during the Bush administration, that critical patient protection, the right to control who sees information, was eliminated for electronic systems. Congress has just put protections for privacy into the stimulus package for health I.T. funds that are going to be distributed, $19 billion.

So we think that Congress and the new president are moving in the right direction to make sure that we have an ethical, trustworthy system.

RAY SUAREZ: Dr. Berwick, how do you respond to Dr. Peel's concerns?

DR. DONALD BERWICK: I agree with Dr. Peel. Every technology, even those as promising as electronic record, carries with it both risks and benefits.

The benefits here are enormous. It's hard to overestimate...


DR. DONALD BERWICK: ... how much damage is done by the discontinuities in information transfer and cooperation in health care. But there are these risks, and I agree with Dr. Peel.

The way to assure security is both technical -- getting the right designs in place -- and also keeping the record under the control of the patient. If we do that properly, though, this should be a major step forward, not just for DOD and the V.A., but for the whole country.

RAY SUAREZ: Steve Robinson, can we assume for the moment that this is not a silver bullet, that there are problems in the way health care is dispensed both for people still in uniform and out of uniform who have served that are not addressed by simply putting medical records into electronic form and making them easily transferable?

STEVE ROBINSON: Yes, all of the issues that they raised are important. This isn't a silver bullet.

When we talk about health care transformation for the nation at large and focus it down to returning veterans, there are some very unique things that aren't happening for returning veterans that weren't addressed in this electronic medical record issue, one being that we need more mental health care providers.

We need better screening for traumatic brain injury. We don't have the state-of-the-art equipment that we need in the DOD to screen people and catch them before they get sent to the V.A.

So, yes, it's not a magic bullet, because having this electronic medical record is not going to improve the health care that servicemembers receive while on active duty. So we have to get that right, too.

Right now, the V.A. is treating 400,000 OIF and OEF veterans.

RAY SUAREZ: And what does that mean?

STEVE ROBINSON: That means that, of the...

RAY SUAREZ: What are OIF and OEF?

STEVE ROBINSON: Operation Iraqi Freedom, Operation Enduring Freedom veterans. From this war, over 400,000 have come to the V.A. for services. There's another 1.5 million that are eligible waiting in the wings. That's a big burden.

Electronic medical records can help. It will reduce the time that it takes to gather the information from DOD and get into the V.A. health care system and start receiving care. But the head of the snake is getting the care right before they transition out of the DOD, and that's still a big problem.

Privacy is big concern

Dr. Deborah Peel
Patient Privacy Rights Center
[I]t's a conundrum in the military, not having privacy. And not having privacy really does compromise the quality and effectiveness of treatment for mental health.

RAY SUAREZ: Dr. Peel, is the nature of the relationship between someone who enlists and the government different from someone in civilian life, when it comes to something like surrendering your privacy, having the government's ability to look at your most personal facts about your life?

DR. DEBORAH PEEL: Yes, it's quite different, and it's really a conundrum for our active-duty military personnel. For example, the Rand Corporation recently did a study on Iraqi vets, and they found 150,000 of them have post-traumatic stress disorder, but are reluctant to get treatment because, in the military, their records are not fully under their control or private.

And I think the military's really struggling with this. There's the Defense Center for Excellence in Traumatic Brain Injury and Post-Traumatic Stress Disorder. I think the military is trying to figure out how to give people privacy.

But you may know this. I'm a psychiatrist and a Freudian psychoanalyst, so I'm very well aware of how sensitive people are about seeking mental health treatment if they think someone else can read their records.

This in particular is not so much an issue of employment -- although many people are discriminated against for seeking mental health treatment -- but it's really about people being reluctant to tell the health professional what really bothers them if they think it's going to be exposed.

So it's a very difficult issue for the military. You know, many of us have seen active-duty military personnel who come and pay cash because they don't want to risk someone else seeing their records.

So I think the military is really facing this now at the Defense Center for Excellence in trying to figure out how to make treatment private, but at the same time they wouldn't want someone who was violent and mentally ill to hurt themselves or hurt others.

So it's a conundrum in the military, not having privacy. And not having privacy really does compromise the quality and effectiveness of treatment for mental health.

Two departments working together

Dr. Donald Berwick
Institute for Healthcare Improvement
[H]ow can we make the same kind of commitment to all Americans...the way the DOD and the V.A. now apparently intend to for their beneficiaries?

RAY SUAREZ: Dr. Berwick, this approach is being widely talked about as kind of a test drive for a large group of patients to go on to electronic records because President Obama sees this as an approach that can be used in providing health care for more Americans in all walks of life.

How do you craft policy that addresses some of the concerns you've heard about to make this something that can be applicable widely in the United States?

DR. DONALD BERWICK: We need the privacy rules that Dr. Peel is referring to. And I think also what Steve was saying was exactly right. If we automate a broken system, we get an automated broken system.

And we have to pair the development of the electronic record and the seamless exchange of information with a commitment to make the care what it should be.

What's exciting about the DOD and the V.A. is that these are people who together, I think, really do feel responsible for a population. And they want to say to the veterans and the returning warfighters, "We've got your backs, we're with you, and we're going to be with you for a long time."

That's a cultural social commitment. The policy implication here is, how can we make the same kind of commitment to all Americans that we're going to help them through their journeys through their lives and their illnesses the way the DOD and the V.A. now apparently intend to for their beneficiaries? That's the challenge.

RAY SUAREZ: Steve Robinson, briefly before we go, what does it mean to have the Department of Defense and the Department of Veterans Affairs working together on this project? Have there been problems in the past?

STEVE ROBINSON: Yes, it's incredible. Like I said, it was a seven-year journey to see a president stand up and make this happen.

It's an important relationship. You know, the reason they call it the seamless transition, which is what everybody talks about, is that, when you go and serve your country, and you transition out of the Department of Defense to the Department of Veterans Affairs, there should be no gap in care, no stop in care, and everything that you need should be provided.

And now, under this administration, it looks as if they're going to pair the two departments together, especially with electronic medical records, and try to ease that transition to truly make it seamless. And it's incredible to witness.

RAY SUAREZ: Doctors Berwick and Peel, thanks a lot. Steve Robinson, good to see you.