Saturday, September 5, 2009

Hospital Considers Electronic Records

Hospital Considers Electronic Records
WCA Hopes To Take Advantage Of Stimulus

You've been sitting on the exam table idly kicking your feet and reading the posters on the wall for what seems like an eternity. The swollen glands that have kept you awake for the last few nights throb painfully and you feel achy, cold and tired.

Soon, though, the doctor enters the exam room, laptop in hand. Setting the computer on the counter, your doctor gently palpates your throat and asks you a few questions. Satisfied with the exam results, the doctor picks up a stylus, pokes at the laptop's screen a couple of times and tells you that your prescription will be available at the pharmacy shortly.

That's how - with a not-so-gentle nudge from the federal government - visits to the doctor's office will go in the near future. The American Reinvestment and Recovery Act dedicates nearly $20 billion to information technology for the health care industry.

The vast majority of that money - some $17 billion - will flow directly to physicians and hospitals through the Medicare and Medicaid programs. Starting in 2011, physicians and hospitals who adopt certified electronic health record systems will be eligible for extra money. But that carrot is also attached to a stick - those who fail to adopt electronic health record systems by 2015 will miss out on those federal subsidies and will get reduced Medicare payments as a penalty.

To qualify for those federal subsidies, providers will need to demonstrate they're using electronic health record systems in a ''meaningful'' way, though the government has yet to define ''meaningful.''

But one way or the other, health records will soon be created and maintained without the use of so much as a single piece of paper.


At least one local physician office has already made the move to electronic health records.

Ten years ago, Family Health Medical Services, which has offices in Jamestown on Dunham Avenue and Jones Hill, invested several hundred thousand dollars in an electronic health record system - and Dr. Robert Berke says the system has ''really streamlined the way we do things.''

''I can remember the days when I'd have a stack of folders on my desk about two feet high,'' Berke said. ''They were all the medical records I'd have to go through before I could leave for the day. Now, I have a laptop and I just need to make a few clicks on each person's profile. And better yet, I can log in to the system from my home and send in prescriptions or make notes that I didn't have time to make during the course of a day.''

Family Health Medical Services uses Medent's electronic medical record system.

That system presents health care providers with an interactive screen showing a list of patients that need to be seen in a day. It includes their appointment time; a code signifying the visit's purpose; the patient's name; a field listing whether the person has arrived for their appointment, already been seen or has had to reschedule; the time they were shown to a room and the number of the room they're in.

Using the system, physicians can click on a person's name to pull up their medical record, which includes links to the patient's past medical history and family history. The physician can write an electronic note to include as part of the medical record or, for offices that use dictation, can instantly record a transcription voice note that is attached to the electronic record.

''There's so much this allows us to do,'' Berke said. ''We're still learning about it. I think I learn something new about this system every day.''

Berke said the system allows him to be ''much more efficient'' with his time than the old paper records.

''With those old folders, you were always taking a chance that a piece of paper would work its way loose and fall out,'' he said. ''And if someone in billing needed a patient's file, it might be sitting on a physician's desk for a couple of days waiting for the loose ends to be tied up. It was very bulky and very inefficient.''

But now, thanks to the new electronic health record system, Berke said his time is ''better spent.''

''The paperwork has been streamlined and eliminated,'' he said. ''With just a couple of clicks, I can update a patient's record and save it. I can revisit it at home if I need to. I can instantly send prescriptions to any pharmacy. Anybody here who needs to get to a patient's file can get to it when they need it. And it has become much easier to send a patient's record to a hospital should they need surgery.''

The system has proven invaluable over the last 10 years, Berke said.

''I really don't think I'd go back to the old system,'' he said.


WCA Hospital is moving toward a hospital-wide electronic health record system. The hospital is in the process of evaluating different vendors and the systems they offer, according to Dianne French, the hospital's director of health information management.

The hospital has been searching for an electronic health record system for at least the last nine years, according to Keith Robison, the hospital's chief information officer. But the costs associated with implementing such a system for a hospital - infinitely more complicated than that for a physician office - prevented the hospital from taking what Robison called a ''big bang approach.''

That's because the stimulus package doesn't offer hospitals and medical centers any money to cover the up-front costs of implementing electronic health records. And that's a problem because a hospital's electronic health record system must be more complex than that implemented in a private physician office. That's because a hospital setting offers several different so-called ''points of capture'' for a patient. In a private physician office, the patient can only come in one way - by making an appointment. But in a hospital, a patient could come in through the emergency room, through the surgical ward, or in any one of a number of specialty departments for an appointment.

''A lot of systems will need to work together in order to create an electronic medical record for a hospital,'' Mrs. French said. ''There are systems we use to schedule and pre-admit. They need to work with systems already in place all over the hospital and work with systems that we have yet to implement. That's part of the challenge. Every system has to talk to each other.''

All of that means WCA will spend millions of dollars to purchase and implement an electronic medical record - money it doesn't have. But the hospital is working with vendors to see if they will extend to the hospital a line of credit to allow for the purchase of an electronic health record.

Hospital officials know they will need to purchase software - the most expensive portion of an electronic health record - but its still unclear what the hardware portion of the electronic health record will look like.

''It could be computer carts, wireless tablets, laptop computers or even computers embedded in the wall,'' Robison said. ''We just don't know. Each department is going to need its own method - and that method could differ between departments. It just depends on what's the most usable for the people in that particular department.''

Since the federal government in May announced the stimulus package contained money for health information technology, WCA has gone through what Robison called ''a fast-paced plan'' that will allow the hospital to take advantage of as much stimulus money as possible. Their goal - to implement electronic health records within the next 18 months.

WCA already has electronic medical records in radiology, lab and pharmacy, Robison said. That means the hospital is already a Level 1 electronic medical record according to the Healthcare Information and Management Systems Society, or HIMSS.

''We need a system that's easy for the physicians to use,'' Robison said. ''Otherwise, it's not worth it.''

There are a number of issues the hospital has yet to address - among them how best to make the millions of pieces of paper that already exist as patient records part of an electronic record system. There are security concerns, too, such as whether to implement biometric measures for those who need access to electronic patient records.

Even so - at least for Mrs. French - the move to electronic health records is an exciting one.

''I've been here for 32 years, and this has been a dream of mine for at least the last 10 years,'' she said. ''It's exciting to finally be making this move.''

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