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Digital revolution takes on medical records

Posted: April 5, 2012 2:00 a.m.
Updated: April 5, 2012 2:00 a.m.

Dr. Bud Lawrence from the Emergency Department at Henry Mayo Newhall Memorial hospital uses a Workstation on Wheels, which can be moved anywhere in the hospital to enter information into patient records and create an electronic medical record.

 

For decades, technology has advanced the prevention, diagnosis and treatment of patient illnesses and diseases in the medical field.

Yet the documentation of patient care has remained mired in the archaic process of handwritten notes — until now.

A 2009 law aimed at creating electronic medical records and linking the information to key parties also provided some $20 billion in funding to get doctors and hospitals to convert from handwritten to electronic records.

Henry Mayo Newhall Memorial Hospital already had a system installed in its emergency room in October 2007, originally set up to handle financial records, said Kelly Wildhaber, director of American Recovery and Reinvestment Act — Health Information Technology for Economic and Clinical Health compliance, privacy officer for the hospital.

“We’ve been progressively rolling out more and more of the functionality over the course of the last four years,” Wildhaber said. “Last year, we went live with an advanced clinical system for all of the nursing and support staff.”

Last fall, Henry Mayo also went live with electronic medical records in its OBY/GYN department, she said. The hospital is hoping to have everything documented electronically by 2014 — one year ahead of the deadline for completion.

Getting doctors onboard is the last phase of having medical personnel use the system, scheduled to begin this year, although physicians in the emergency department first began using the system in September 2010, Wildhaber said.

Bringing doctors online last might frustrate some patients trying to read their doctor’s handwriting or prescriptions.

Having doctors adapt to using the systems last is for a good reason, said Elizabeth Petrich Kennedy, chief nursing informatics officer with Providence Health & Services, Southern California.

 

Doctors

First, hospitals want to make sure the system is working seamlessly, Kennedy said. To do that, medical centers often install systems in areas with the highest number of employees, such as nursing staffs, who will make frequent use of a new system, providing critical feedback.

As for the doctors, some only admit patients but don’t practice at the hospital itself, Kennedy said. And many doctors practice at several hospitals and are not employees of the hospitals.

“It’s very difficult for doctors to learn five different systems at different hospitals,” she said. “And it’s a tremendous amount of cost to them to have to come in on their own time for training.”

Also, hospital directors don’t have the authority to order nonemployee doctors to come in for training, Kennedy said. Providence Health & Services of Southern California expects to have doctors using their system within the next 1 1/2 years at all five of its hospitals, including Holy Cross Medical Center in Mission Hills.

“Henry Mayo was already going in the direction of converting records electronically before the government ordered it because it’s the right thing to do for the patients and staff,” Wildhaber said.

 

Benefits

Both Wildhaber and Kennedy agree there are many benefits to converting to electronic records.

“It will provide a number of benefits for the patient and help us with patient safety and improved quality patient outcomes,” Wildhaber said. “It also allows patients to be more involved in their care and have easier access to their information.”

A doctor seeing a patient in the hospital may need to order oxygen and five different medications to be given at different times, Kennedy said.

“Historically, this was written out on piece of paper and given to someone to enter into a computer system or faxed to the place they need to go to,” Kennedy said. “The handwriting could be illegible, or after it went through a fax machine and was translated by another person, there was an even higher risk of error.”

When doctors begin entering orders electronically, it will eliminate transcription errors and vastly improve patient care, she said.

Both hospital groups have also been scanning bar codes on medication to verify the right medication is given to the right patient.

In August 2011, Henry Mayo conducted a pilot program in the women’s unit and found scanning medication bar codes may prevent up to 50 percent of medication errors, Wildhaber said.

Electronic medical records also improve coordination of care for patients, resulting in fewer readmissions by providing good continuity of care, she said.

“We see patients all the time who want access to their records for another doctor or because they were going to travel,” she said. “With electronic records, there can be a quicker turnaround of records. We can send the information to a doctor before the patient gets there.”

Having access to patient records also assists in treating patients with multiple issues and doctors, Wildhaber said. The treating doctor can access all of the information from the computer, preventing delays in care.

Under the handwritten system, clipboards go with patients, or physical therapists walk into a patients’ rooms, so the chart might be deemed missing because the nurse has it, Kennedy said.

“Now the information is immediately accessible at all times,” she said. “A nurse will enter the vital signs, and it’s available to everyone handling patient care.”

Both medical organizations use Workstations on Wheels located throughout different units of hospitals so anyone caring for a patient has access to enter medical information electronically. Some departments also have a personal or tablet computer in patient rooms, Kennedy said.

And, in the case of Providence, medical professionals will have immediate access to records if a patient transfers to another hospital. In a few years, she said, a there will be access to a patient’s record at 27 of its hospitals in any part of the country.

Getting the systems into all areas of practice, however, is a very complex and expensive undertaking, which costs millions of dollars, Wildhaber said.

“But right now, we have a carrot and a stick. Early adopters who jump on board quickly have benefits,” she said. “By 2015, if hospitals don’t comply, there will be penalties.”

 

Adoption

One of the provisions of the American Recovery and Reinvestment Act signed into law on Feb. 17, 2009, was the Health Information Technology for Economic and Clinical Health.

The HITECH Act, as it is referred to, called on the medical communities to create electronic medical records to link health care providers, health plans, the government and other interested parties for the purpose of electronically accessing health information.

Some $20 billion is being pumped into the heath-care system as an incentive to for doctors and hospitals to go digital. And doctors are now getting extra Medicare payments if they convert.

Those medical care providers who do not convert and adopt electronic medical records will eventually face penalties.

Despite the costs, the benefits to the public are expected to be widespread.

For example, Wildhaber said, “We can pinpoint epidemics.”

And by gathering data on geographic area, race, ethnicity, age and sex, all critical to understanding the disease process, experts can look at the national level to drive education and research aimed at preventing a million heart attacks and strokes or control diabetes, she said.

jadkins@the-signal.com  /  661-287-5599

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