Electronic medical records transforming health care
by Mason King
Ronald Burgess, an Air Force veteran who barely survived a motorcycle accident in 1969, has limped through four decades with persistent spinal, knee and wrist woes, not to mention diabetes and hypertension. His collected charts, test results, X-rays and drug lists — he takes 17 medicines a day — would dwarf several encyclopedia volumes when loaded on a doctor’s shelf. But accessing his medical records through the Department of Veterans Affairs is as easy as punching in a password when Burgess visits the Chalmers P. Wylie Ambulatory Care Center in Columbus, Ohio.
Every byte of Burgess’ treatment data is available through a database linking hundreds of VA health care facilities. Burgess can view and print his medical history from a computer in the exam room.
Doctors can gauge their own effectiveness with electronic medical records. >>
When a doctor prescribes medicine, the script zips electronically to a VA pharmacy. When Burgess visits another VA center to check on his bum knee, his records are automatically in the system. As a result, he’s more confident in the quality of his care.
“Whether you’re seeing your primary doctor or someone else, they can quickly update themselves on all the most recent annotations to your records,” Burgess says. “They don’t have to guess what was done or try to find out.”
Electronic medical record systems — or EMRs — are exerting a revolutionary influence on the practice of medicine, and the revolution is knocking on your doctor’s exam-room door. That is, if it hasn’t already barged through.
Citing the potential for streamlining and improving patient care, President Obama made EMRs a pillar of the nation’s $787 billion economic stimulus plan in February. He has pledged that every American will have an electronic medical record by 2014.
Angie’s List members are on board, or want to be. A recent online poll found that 70 percent of members are in favor of EMRs, citing their ability to boost communication between caregivers and improve health care in general. Forty-one percent say their doctors already use an EMR system. “It makes my life so much easier,” says Sara Duse of Peoria, Ariz. “It speeds up patient care and makes it more accurate.”
How many doctors use EMRs?
A national survey in 2008 found that fewer than one in five doctors have adopted electronic medical record systems in their office practices. >>
Instead of managing a patient’s health on paper, physicians use EMR systems to collect the information via a computer in the exam room and then store it on a central system. No more chasing after lost charts or trying to decipher illegible scribbles.
From there, it’s like bringing a consulting physician into the room. Smart EMR systems can prompt the doctor to offer tests or advice based on the patient’s medical history, or warn of unusual test results and potentially harmful drug interactions. “Not only does it make you more efficient, but it makes you feel like a better doctor,” says Dr. Joseph Heyman, chair of the American Medical Association’s Board of Trustees.
When Dr. Joseph Heyman, an OB-GYN in Amesbury, Mass., started a solo practice in 2001, he hired a techie to set up an EMR system. A year later, a corrupted file caused Heyman to lose information on more than 1,000 patients. “This is one of the reasons why people aren’t comfortable yet,” he says. “I think everybody in the back of their mind worries. And I still worry. I back up in triplicate.”
EMR systems can connect doctors in a single practice and then share patient data with clinics, hospitals and pharmacies — if their systems are linked and compatible.
“We have a horribly inefficient health care system, through which bad care is delivered,” says Dr. William Tierney of the Indianapolis-based Regenstrief Institute, which has pioneered and studied the use of EMRs for more than 35 years. "The first thing you do is improve the information management.”
But the change isn’t likely to happen overnight. Only 17 percent of the nation’s physicians use even a basic electronic medical record system, according to a 2008 study published in the New England Journal of Medicine. Only 4 percent operate fully outfitted systems. An April study in NEJM found that no more than 12 percent of U.S. hospitals operate basic EMR systems, although some have adopted individual functions, such as electronic lab reports.
“The challenges are major,” says Dr. David Blumenthal, Obama’s national coordinator for health information technology. “We’re trying to change the way in which medicine is organized, trying to add new technology into the daily work of care.”
Instead of a universal electronic records system linking the country’s 800,000-some doctors, there are pockets of practices and care centers across the U.S. using EMRs. They range from solo practices to hospitals to citywide networks to systems connecting hundreds of facilities across the country. Notable examples include the VA’s national system, which links 153 hospitals, 764 community clinics and 134 nursing homes; and medical group Kaiser Permanente, which maintains electronic records on its 8.6 million members across nine states.
Systems that connect several different health care providers give doctors immediate access to vital patient data. Tierney uses the example of a man who checks into an Indianapolis emergency room with chest pains. Through the Indiana Network for Patient Care, which culls data on patients in five Indianapolis hospital systems, Tierney might find that the man received a recent cardiac catheterization.
“If it’s clean, that would reassure me that this person wasn’t having a heart attack,” Tierney says. “Without that, I might say, ‘We may have to admit you to the hospital and watch you for a day.’ And there’s $5,000 down the drain.”
Angie’s List member Annmarie Galli worries that digitizing her health data makes it easier for hackers or nosy medical staffers to steal. “You can build the best systems to prevent people from looking at your information, but as anyone who has a credit card knows, it’s impossible to prevent a breach,” says Galli of Winchester, Mass.
Many members who responded to an Angie’s List online poll fretted over the safety of their EMRs. Health officials will address beefing up data protection this year as part of the HITECH Act.
Despite a few well-publicized cases of health data theft, Dr. Greg Kiray of IU Medical Group Primary Care in Indianapolis says he has full confidence in security measures for EMR systems. “The benefits of sharing health information between your doctors, in my view, far outweighs the very, very small but real risk of access violations,” he says.
EMRs can save consumers and caregivers money in many other ways. For example, Kaiser Permanente cut expenses for storing and transporting paper records.
EMRs also eliminate superfluous tests and appointments.
Another perk enjoyed by patients in some systems is viewing their health records online using a PHR, or personal health record. Many PHR systems allow patients to order prescription refills, and for patients and doctors to shoot messages back and forth. “Before this, you had to go through two other parties before a message got through to your doctor, and sometimes it was garbled,” says Angie’s List member Romay Westrick of San Diego. “This way, I can contact my doctor directly, tell him what my problem is and what I want.”
So, if EMRs are so valuable, why do so few doctors use them? “The problem is these systems are expensive ... and doctors don’t benefit from them financially,” Tierney says. “It doesn’t bring in any more money, and it doesn’t really help you see patients any faster. So, there’s a disconnect between the cost and benefit of electronic medical records.”
Doctors and hospitals soon will catch a break on cost. Obama and Congress earmarked $17.2 billion in February’s stimulus package to provide incentives for adopting EMRs. Called the HITECH Act, the program employs sticks and carrots to encourage EMR use by those participating in Medicaid and Medicare — as much as $44,000 to $64,000 in bonuses between 2011 and 2015 for doctors, and millions for hospitals. Reductions in Medicare payments for those without EMR systems will begin in 2015.
The Act qualifies as economic stimulus in part due to the number of jobs EMR use is expected to create — as many as 50,000 to 70,000 infotech workers, according to some experts. Policymakers are hashing over several thorny details of implementing the plan, including how to get unfamiliar EMR systems to exchange information with each other and how to ensure data privacy.
Whether Obama can fulfill his promise by 2014 remains to be seen. The Congressional Budget Office estimates that 90 percent of physicians and 70 percent of hospitals will adopt the necessary technology by 2019.
Despite their ability to trim medical expenses, EMRs probably won’t erase continuing cost increases in health care. “Electronic records won’t reverse our costs,” says Dr. Andy Wiesenthal, who was instrumental in implementing Kaiser Permanente’s HealthConnect system. “They will make costs less of an issue than they would have been [without them].”
Dr. Farzad Mostashari heads New York City’s Primary Care Information Project, which has helped supply EMR systems to more than 1,200 primary-care physicians in the city’s poorest areas. He cautions that doctors will need adequate training and a clear vision for EMR systems. “The technology is not an end unto itself,” he says. “It’s a means to improving health, and that perspective has to permeate every aspect of what we do. Otherwise, what we’ll end up with are electronic health records, not health.”