Doctors, hospitals advised to keep records electronically.

According to the Washington Post, about 10 percent of physicians' offices, and even fewer hospitals, now use electronic medical records exclusively. But a recent report suggests this is not good enough.

In "Patient Safety: A New Standard of Care" the Institute of Medicine called for hospitals and doctors to adopt electronic recordkeeping systems that would prevent tens of thousands of fatal medical errors annually and form the foundation for a nationwide exchange of patient information among practitioners and medical facilities.

The U.S. government would set standards for electronic records and error-surveillance systems but would not tell hospitals and clinics what systems to buy. Use of such systems, which can guide treatment decisions as well as catch mistakes, would be voluntary, said the institute, which advises the federal government on medical policy. The institute recommended, however, that electronic recordkeeping and participation in a national information network should become conditions for participating in programs such as Medicare, thus making them essentially mandatory.

The health information infrastructure envisioned by the authors of the report would give the U.S. government an unprecedented role in day-to-day medical practice.

The government would set the technical standards for information exchange, define medical errors, and tell hospitals what information to collect. It also would help specify what decision support functions computer systems should offer to physicians as they order tests, diagnose illnesses, and devise treatments. The government would oversee the "root-cause analysis" of errors and near misses and disseminate information about fixes and lessons.

The system would also create a much larger and more seamless network for disease surveillance. For example, it could allow a doctor in Seattle to read the clinic notes and x-ray reports of a patient treated in New York and report an adverse drug reaction to the Food and Drug Administration--all from a personal computer.

Perhaps most important, the report's authors hope to reduce medical errors. A 1999 report estimated that at least 44,000 Americans--and possibly as many as 98,000--die of medical errors each year.

Under the proposal, many federal agencies would take on new responsibilities, notably the Agency for Healthcare Research and Quality and the National Library of Medicine, as well as several committees in the Defense and Veterans Affairs departments that are already at work standardizing information flow among themselves. The government's role could hasten what many medical systems are desperately trying to do--move from the Dark Ages of unreadable and untraceable paper records and to a future where information is a mouse click away.

"Health care is the most information-intense enterprise in the country. It is 20, 30, 40 years behind less information-intensive industries like banking," Kenneth W. Kizer, head of the National Quality Forum, a Washington nonprofit association, recently told the Washington Post.

The first step, according to the institute's report, is to adopt an electronic health record system that gives practitioners immediate access to patient information from all sources and alerts them to impending disasters, such as drug interactions and dangerously abnormal lab results.