Computerworld — President-elect Barack Obama has said that a national electronic health records system will be a priority in his first term, not just for streamlining workflow at hospitals and physician offices but to cut costs and improve the quality of health care. And while he has pledged to invest $10 billion a year over the next five years on the effort, the price tag for such a system could be closer to $100 billion over the next 10 years, according to experts. They also note that sticking to his five-year time-table could prove to be daunting.

Money for the e-health records (EHRs) system would come out of the $825 billion economic stimulus package Obama hopes to push through Congress.

"The magnitude of what we're going to need to do on the Obama scale is just incredible to think about, when you consider linking all these medical records across all these different towns, cities, states," said Dr. Charles O. Frazier, a vice president of clinical innovation at Riverside Health System in Newport News, Va. "We have enough of a problem with that in our own health system."

In 2004, President George W. Bush called for establishing EHRs for most Americans by 2014. Bush created the Office of the National Coordinator (ONC) for Health Information Technology to lead the way. The ONC pushed several pilot projects and created standardized medical records. Even so, a survey of 2,700 U.S. doctors by the New England Journal of Medicine last July showed only 4% were using "fully functional" EHR systems; the rest are all still paper-based.

Currently, only 25% to 35% of the nation's 5,000 hospitals use -- or are in the process of rolling out -- computerized order entry and medical record systems, according to Dr. David Brailer , who served as President Bush's health information czar from 2004 to 2006. Full EHR systems include patient care order entry systems and networks to share patient data between hospitals, primary care physicians and insurance companies and fill pharmacy prescriptions.

"It's a multi-year implementation. Hospitals will have to make a sizable, potentially multi-hundred-million dollar budget commitments," Brailer said. "But the $100 billion is a one time cost over the course of a decade. That's in an industry that spends $2.2 trillion a year now and 10 years from now will spend $3.7 trillion per year. So it's a relatively small amount of money."

Brailer said the nation stands to save between $200 billion and $300 billion a year once an EHR system is in place by cutting down on duplications, reducing errors that generate expensive care later, avoiding fraudulent claims and better coordinating care between primary care doctors, hospitals and specialists. The idea is "just to create a more efficient workflow," he said.

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