Tucked inside the $819 billion economic stimulus package that passed the House yesterday are provisions to spur the adoption of electronic medical records.
The relatively modest $20 billion for health information technology would be, by far, the biggest government infusion to enable medical information to follow patients back and forth among doctors' offices, hospitals and other providers.
If successful, experts say, electronic medical records would improve quality, reduce duplication of services, and limit errors - ultimately saving the nation hundreds of billions of dollars each year.
The federal money is likely to boost regional efforts in New Jersey, Pennsylvania and other states, such as a public-private project now ongoing to improve chronic care given by primary-care doctors in Philadelphia and its western suburbs.
"We are not tinkering around the edges here," said Rep. Allyson Y. Schwartz (D., Pa.). "The investment of these kinds of dollars means we are looking to a goal of getting 90 percent of physicians in this country using secure, confidential electronic medical records [that other providers can also access] within the next 10 years."
Schwartz said federal leadership was needed to push for quick implementation. That is especially true in areas such as the Philadelphia region with a large number of competing hospital systems and doctor practices that don't share information, she said.
But some key advocates of electronic medical records expressed concern that the House bill, while injecting needed cash into the process, contains provisions that could erase progress already made.
"I am really elated that Congress . . . finally appears to understand the value of health information," said David J. Brailer, the first national coordinator of health information technology under President George W. Bush.
But Brailer, a physician who has a Wharton School doctorate in health economics, said the House bill went so overboard on privacy that it may inhibit the flow of information. He also faults the measure for having the government develop the infrastructure for medical records rather than nonprofit groups.
The bill would make available $2 billion - it's $5 billion in the Senate version, expected to be voted on next week - to states in grants and loans to help put electronic records systems in place.
Starting in October 2010, hospitals, doctors and others would be able to get increased payments from Medicare and Medicaid for using such systems.
Doctors would be eligible for $40,000 to $65,000 for "showing that they are meaningfully using health information technology." Hospitals could qualify for several million dollars, and money would also go to federally qualified health centers, rural clinics and others.
Some South Jersey health systems have already begun to join in a regional health information exchange led by AtlantiCare. Nearer Philadelphia, Virtua Health will soon have a medical record system in Burlington, Camden and Gloucester Counties that will also tie into the AtlantiCare-led effort.
Last March, Gov. Rendell established a statewide health information exchange to encourage the sharing of information.
And in north-central Pennsylvania, the Geisinger Health System is on the verge of implementing electronic health records across its three hospitals and more than 700 doctors. That system took a decade to build, and Geisinger chief technology officer Ronald A. Paulus, while applauding the federal effort, cautioned against moving too quickly.
"I love the enthusiasm, I love the excitement, I love the funding," Paulus said, "but it needs to be linked to a process that allows this to be done with a reasonable degree of care."