American College of Physicians Issues E-Health Recommendations

Health care may be the fastest growing industry, but it has been slow to adopt the use of technology. While orders at fast food chains are now entirely automated, most physician offices and hospitals still maintain their records on paper.

In a new position paper, the American College of Physicians (ACP) states that collaboration among physicians, patients, technology developers, and policymakers must occur if e-health activities like electronic communication between physicians and their patients, remote monitoring of patients, personal and electronic health records, and patients seeking health information online are to transform health care in the United States.

"E-health activities have great potential to improve the quality of patient care, reduce medical errors, increase efficiency and access to care, and achieve substantial cost savings," said David C. Dale, MD, FACP, president, ACP. "Furthermore, e-health is a critical part of the patient-centered medical home model of care, which in coordination with the other components, is the future of the U.S. health care delivery system."

The paper, "E-Health and Its Impact on Medical Practice" (www.acponline.org/advocacy), analyzes the benefits, technical and financial challenges, and legal issues related to adopting and implementing e-health activities for physicians and patients.

The challenges for implementing e-health activities effectively, ACP staes, lie not only in the adoption of universal technical standards for the exchange of electronic health information, but also in a more fundamental concern of economic support for health information technology.

For physicians, the financial costs of purchasing systems and incorporating e-health offerings can be considerable.

"Widespread adoption and use of health information technology can positively affect access, care coordination, patient satisfaction, and clinical outcomes," said Joel S. Levine, MD, FACP, chair, ACP Board of Regents. "Payment policy reforms, however, are necessary to appropriately compensate physicians for their investment in and implementation of e-health services."

Confidentiality, privacy, and standardization also are needed to create a trusted nationwide health information network. Health care providers and individuals are likely to be reluctant to adopt e-health activities unless they are confident that systems are secure and accurate. ACP calls on technology developers and policymakers to support standards that address interoperability, functionality, security, privacy, content, and legal liability.

A significant legal reason why physicians are reluctant to communicate via e-mail is because of the potential lack of security in using this technology and its impact on patient confidentiality and privacy. ACP, therefore, recommends the use of secure Web messaging infrastructure rather than standard e-mail to ensure the highest levels of privacy and confidentiality that are currently available for electronic communications between physicians and their patients. Records of communication must be protected in accord with the requirements of the Health Insurance Portability and Accountability Act.

ACP further recommends ongoing investment in demonstration projects to assess the benefits of e-health activities within the context of the patient-centered medical home. Several demonstration projects of the patient-centered medical home are in development and will test elements of e-health.

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