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Filed Away for Good

So long, paper files: Electronic health records are moving in at hospitals and doctors' offices all over town.


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Laser scalpels and biotech drugs are just a few of the newer tools of medicine in the modern age. Yet when it comes to medical records — clumsy clipboards and office cabinets stuffed with paper files — most healthcare providers are lumbering in the Ice Age.

But a big thaw is on its way. Though many industries tossed pen and paper years ago, healthcare has lagged because there has been little financial incentive to make the costly move. Now, with roughly $20 billion in economic stimulus money earmarked by Congress to help hospitals and doctors convert to electronic health rec­ords, healthcare providers nationwide are rushing to make the digital switch. Incentives — and the looming threat of penalties — are spurring change. Doctors and hos­pitals that convert will be eligible for bonus payments from Medicare and Medicaid, beginning next year. And those who don’t switch face reduced reimbursement fees by 2015.

“Everyone has been talking about electronic medical records for the past 15 years, but less than 10 percent of healthcare organizations have moved to them,” says Alan Portela, president of CliniComp, a San Diego firm that has been developing electronic rec­ords systems since 1983. “Now the federal government has gotten serious about it and provided enough funding to help hospitals make the switch. It will open the door to new technologies, innovations and collaborations.”

Studies indicate that electronic health records can improve patient safety and generate savings by minimizing duplication of treatments and procedures.

In San Diego County, Kaiser ­Permanente has already made the transition to a paper­less medical record system, and UCSD Med­i­cal Center expects to finish its digital transformation by the end of the year. Everything once logged or stored on paper and film — from patient charts to prescription-refill orders to medical images — will be in electronic files that can be accessed through computers and compatible wireless devices by hospitals and medical teams.

And in increasing numbers, by patients. At Kaiser, patients can sign up for KP HealthConnect, a secure Internet portal that allows them to access their medical charts online, e-mail questions to their doctors and receive text messages via cell phone about medication or checkup reminders. It’s already the region’s largest private electronic health rec­ord: 1 million out of 3.3 million Kaiser patients in Southern California participate, and patients and providers exchange about 400,000 e-mails each month.

“It’s a real game-changer,” says Dr. John Mattison, regional director of KP Health­Connect. “Patients love it.”

For patients like Susan Russo, the ability to access her medical records online has proved empowering. “I play a more active role now in my own health,” says Russo, a cookbook author who has been a Kaiser patient for three years. “If I want to check on my results or my medical record, I can look anytime day or night, and I don’t have to have a doctor pull out a chart and walk me through it. This doesn’t replace telephone conversations or face-to-face with my doctor. It’s just another way to keep in contact and to be active in my own healthcare management.”

The UC San Diego Health System offers an Internet portal, called MyUCSDChart, that allows patients to access medical records, view test results, request prescription renewals and e-mail physicians.

Dr. Joshua Lee, medical director of information systems at UC San Diego Health System, says about 14,000 out of roughly 125,000 patients regularly use the system. “We have about a 15 percent capture rate right now, but if you look at the curve, it is growing each month,” says Lee.

Still, there are growing pains. Some physicians and consumers worry that reliance on electronic medical records will limit direct doctor-patient contact. And some physicians complain that current electronic health record formats create a clerical burden that detracts from the practice of medicine.

“The days where doctors are hand-writing patient notes are over,” says Dr. Kevin Pho, who hosts KevinMD.com, a popular blog that provides physician commentary on national medical news and trends. However, he says many electronic medical record interfaces are “clunky,” and most aren’t compatible for exchanging patient information between rival hospitals or even between a hospital and a physician office across the street.

“When you look at interfaces in social networks like Facebook and compare that to the typical electronic medical record, we are [in effect] stuck in Windows ’95,” says Pho. “It’s inevitable that we will get there, but it will take time.”

Several projects involving major private healthcare providers and government entities are aimed at getting the healthcare industry on the same electronic page. In San Diego, a consortium of local hospitals and community clinics this year landed a $15.3 million federal grant to link their electronic medical records systems so patient information can be shared when a patient moves from one health network to another. The consortium was one of just 15 projects nationwide — and the only one in California — to receive funding from the Beacon Community program, which provides grants for innovation and technology through the 2009 federal economic stimulus law.

UCSD Medical Center is the lead facility for the initiative, which includes Scripps Health, Sharp HealthCare, the San Diego Naval Medical Center, the San Diego V.A. Healthcare System and the San Diego Council of Community Clinics.

In January, Kaiser Permanente joined with the Veterans Administration Hospital and the United States Defense Department to launch a pilot program in San Diego to link electronic medical rec­ords.

Dr. Joshua Lee at UC San Diego Health System says, “Patient expectation has increased. They say, ‘I’m able to bank online; why not this stuff?’ Soon electronic health records will begin to drive where patients choose to receive their healthcare,” he predicts.

By the Numbers

$15.3 million
federal stimulus money earmarked for San Diego consortium of hospitals to link their electronic medical records systems so information can be shared as a patient moves from one health network to another

400,000
number of e-mails exchanged between patients and providers each month on Kaiser’s KP HealthConnect system

15
percentage of UCSD’s 125,000 patients who regularly access their medical records online

Electronic Health Records

Pros

  • Fewer drug-interaction mishaps caused by human error (i.e., physician’s handwriting).
  • Reduced costs from fewer repeated tests and medical visits because of conflicting charting procedures.
  • Electronic records could provide huge amounts of patient data for clinical research, translating into more practical, evidence-based treatments.
     
Cons
 
  • Electronic records are costly to implement, especially for smaller hospitals and private practices lacking the scale of major healthcare networks.
  • Steep learning curve for some doctors could translate into awkward fumbling at the keyboard during time-sensitive checkups.
  • Privacy and security concerns about who — insurance firms, computer hackers — might gain access to records.

 

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