It’s generally accepted that replacing paper medical records with electronic ones should reduce errors, and save lives.
Yet most doctors’ offices still rely on paper records, because converting to an electronic system is costly and complicated.
It can easily cost US$60,000 per doctor, if each physician goes it alone, says Dr. John Halamka, CIO of the CareGroup Healthcare System in Boston.
That’s why the physician group affiliated with CareGroup’s Beth Israel Deaconess Medical Center in Boston has begun a $4 million project to help a few hundred doctors upgrade to electronic records. With a shared infrastructure, Halamka says the per-doctor cost will go down to about $25,000, and the hospital and physicians’ group will pay for 85% of each doctor’s implementation costs.
“Doctors’ offices are a big sea of paper,” Halamka says, explaining why “for the first time, hospitals are becoming IT providers for … community doctors.”
A large majority of medical records are already electronic in the four Caregroup hospitals that Halamka oversees. The three-year-project, which will begin with pilot sites in the first half of this year, focuses on about 300 doctors who are affiliated with the Beth Israel physician group and are spread through Massachusetts, Rhode Island and Maine.
These doctors are still in the paper-based world, as are most of their peers. Less than a quarter of physicians nationwide reported using any kind of electronic medical records in U.S. government survey results released in 2006. Only 9% of doctors nationwide used a complete electronic medical records system, comprised of computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes. Beth Israel is partnering with Concordant, a vendor that will help build and manage the electronic records infrastructure, delivered to doctors via their Web browsers. Concordant will run the application, hosted on servers in a co-location facility in Marlborough, Mass., and provide desktop support to doctors. With a centralized infrastructure, a single doctor’s office won’t need to buy its own servers or manage Oracle databases, Halamka says. They’ll just access the records system on the Web, while Beth Israel and Concordant provided the application and a step-by-step guide on how to convert paper records into electronic ones. “It’s like a Starbucks model,” Halamka says. “Do you think Starbucks hires a new contractor every time they build a new store?”
Beth Israel is just one of many multi-hospital systems working on electronic medical records. Government pressure and potential regulations will certainly spur larger-scale efforts to go electronic over the next decade, says Dr. Tom Karson, chief medical information officer at Continuum Health Partners in New York. President Bush has stated that every American should have a personal electronic medical record by 2014. The need to safeguard patient privacy is one major roadblock that could delay such a lofty goal, and is something Continuum and its five hospitals took seriously over the past several years as they rolled out electronic records. “That’s a huge effort,” Karson says. “Obviously, things are password-protected, encrypted in terms of transmission. There is a full audit trail down literally to the individual data level of who viewed what, when and what they did, when they were there. There’s a full audit trail on every item.”
Security may not have been the biggest challenge for Karson, though. The 2,700-bed system had barely any electronic record capability when it began designing the project in 2004, he says. Karson surveyed 5,000 doctors, nurses, and other employees and found that 27% were computer-illiterate — some didn’t even know how to use a mouse.
Plenty of training on basic computer skills was necessary before Continuum deployed its set of technologies, which was extensive. Continuum bought 5,500 desktop computers and 1,000 “computers on wheels,” which nurses can bring to the bedside along with the usual patient care tools.
A wireless communication network was necessary for these mobile computers, and a virtual private network is used for doctors who need to log in from remote sites.
The last of the five hospitals will be going live in the first quarter of this year, Karson says.
Ironically, electronic medical records systems can create new potential for errors, even as it eliminates many basic mistakes, Karson says. With one or two careless keystrokes, a doctor or nurse might put an order in the wrong patient file, he says.
While practitioners should try to avoid any errors, the benefits of an electronic system outweigh those concerns, he says. Automated alerts prevent the prescription of medication that might trigger a patient’s allergy, he notes.
Easy access to data improves efficiency too. For example, if a test is ordered for a patient a doctor might want to know is similar tests have been done previously, to compare results.
“Literally, just the data collection of the current episode was always a problem [when we used paper medical records],” Karson says. “You’d spend a lot of time just finding things. Now you can go to just one place.”