[Bridging_the_digital_divide] Hospitals move toward 'paperless' age

[bridging_the_divide at touchsmart.net]

Hospitals move toward 'paperless' age

Wednesday, August 4, 2004 Posted: 10:23 AM EDT (1423 GMT)


INDIANAPOLIS, Indiana (AP) -- With no patient chart in sight, Dr.  
Sheila Gamache strides into Thom Kolby's hospital room to check on him  
a day after the 54-year-old arrived ashen-faced and perilously close to  
death with a clogged artery starving his heart of oxygen.

Rather than flipping through a clipboard thick with pages of notations  
and test results, Gamache gets up to speed on Kolby's condition simply  
by logging onto a wireless notepad she carries on her daily rounds at  
the Indiana Heart Hospital.

Like a handful of others nationwide, the Indianapolis hospital has  
traded its once scattered medical charts, file folders, X-rays and  
other documents for a unified electronic records system accessible with  
a few keystrokes.

Federal officials who are trying to convince more hospital executives  
to go "paperless" say electronic records can make hospitals more  
efficient, reduce medical errors and lower health-care costs.

The costs of the transition can be high, and many physicians are also  
unwilling to trade the ease of jotting down paperbound notations of  
their patients' statuses for a system that requires them to type the  
same information into a computer.

But concerns aside, digital records are a leap ahead for records system  
rooted in cumbersome 19th century filing systems.

The Indiana Heart Hospital's year-old digital records system allows  
Gamache, a cardiologist, to show Kolby an X-ray movie of his beating  
heart just after he was admitted the day before with a clogged artery  
and in excruciating pain.

"Do you see that right there?" she tells Kolby gravely, pointing to the  
looped movie of the blockage displayed on a flat-screen computer in his  
room. "I'm not kidding, they have a name for these and they're called  
widow-makers."

Kolby, of New Palestine, Indiana, watches the digital movie quietly  
with his sons Tyler, 14, and Caleb, 12, then observes, "That must have  
been the pain I was feeling." He tells Gamache he's feeling wonderful  
and is glad to be alive a day after a surgeon reopened the blocked  
artery by inserting a stent.

After the checkup, Gamache sits down at a computer outside Kolby's room  
-- one of 650 spread across the 88-bed hospital -- to enter notes and  
order changes in his blood-thinning medication.

And all of it without the typical paper trail filled with scrawled  
physician handwriting.

Cost barrier

Despite its digital records system, which cost $15 million to  
implement, the hospital is not fully paperless. It still generates  
paper so that it can interface with the majority of the medical  
community that remains burdened with paper-filled records rooms.

To cut that paper load and meet President Bush's goal of making sure  
most Americans have computerized medical records available within 10  
years, the federal government is trying to move things along.

On July 21, Health and Human Services Secretary Tommy Thompson outlined  
a plan that sets technology standards and provides financial incentives  
for doctors and hospitals to invest in health care information  
technology.

David J. Brailer, the national coordinator for health information  
technology appointed by President Bush in May, said cost has been one  
barrier. He said it can cost tens of millions of dollars for a large  
hospital, or network of hospitals, to make the change. Getting  
physicians, nurses and medical technicians to abandon years of routine  
for a new system is another obstacle.

"We don't just automate the old systems -- we change the way the work  
is done. And sometimes there's resistance to change," Brailer said.  
Younger physicians are less apt to object.

The software must, of course, be reliable and handled with care. A new  
system at a Department of Veterans Affairs' hospital in Tampa, Florida,  
was plagued by troubles that delayed surgeries and sparked  
congressional probes. The VA said last week that it is scrapping that  
system.

Nearly all hospitals do have electronic billing, but adoption of  
electronic health records has been slow. Just 13 percent of hospitals  
and 28 percent of physicians' practices had some level of electronic  
health record systems in 2002, according to HHS.

Lofty goals

Yet the change appears to carry great benefits.

According to a recent analysis by the Institute of Medicine, the  
routine use of electronic records could help reduce the tens of  
thousands of deaths and injuries caused by medical mistakes every year.

Brailer said paperless systems also cut administrative costs by  
eliminating the need to produce, maintain and store enormous numbers of  
paper files. Although it takes doctors longer to enter their patient  
observations on a computer instead of writing them down, he said  
digital records save time in the long term.

Tapping into this new data stream could advance even loftier goals.

The Mayo Clinic and IBM Corp., for example, are collaborating on a  
project enlisting IBM's powerful supercomputers to analyze electronic  
medical records and quickly assess patients' responses to new  
treatments for cancer or other diseases.

The project began when the partners integrated millions of patient  
records once stored in several incompatible formats into a standard  
system. Those records, when combined with data such as the vast body of  
information emerging from analysis of the human genome, could help  
doctors identify disease causes and prevention, Dr. Hugh Smith,  
chairman of the Mayo Clinic Board of Governors, said in a statement.

One drawback that electronic records systems pose for hospitals,  
however, is that they can reduce hospital revenue, Brailer said. That's  
because more efficient systems eliminate duplicated treatments, shorten  
hospital stays and get patients out of intensive care units faster.

"This is an industry that's not necessary paid on the basis of  
efficiency. It's paid on the basis of volume," Brailer said.

Faster turnaround times

Evanston Northwestern Healthcare spent about $30 million to get its  
three Chicago-area hospitals switched to a full electronic records  
system that about 6,200 employees began using last year.

Mark R. Neaman, the company's president and chief executive office,  
said the goal is about $10 million in savings in the first year,  
largely by reducing the data-collection process.

Eliminating the time-consuming dictation and transcription process of  
physicians' patient observations has saved $500,000 alone so far, he  
said.

Neaman said turnaround times for test results have fallen significantly  
at the three hospitals, which have about 50,000 inpatient admissions  
and 100,000 emergency room visits annually. Getting mammogram results,  
for example, now take about a day, not days or weeks.

"If you're a patient waiting for a crucial test result, an hour can  
seem like a day," he said.

The Leapfrog Group, a nonprofit coalition of business and other groups,  
is one of several organizations working to encourage hospitals to move  
to computerized records systems.

Suzanne Delbanco, the Washington-based group's chief executive officer,  
said the biggest impetus for change may come from baby boomers who are  
less willing than their parents to wait around for test results  
demanding more efficient medical care.

"As patients begin to recognize that hospitals are largely in the dark  
ages, they will begin to demand that they get the best care possible,  
which is in part dependent on hospitals using electronic records," she  
said.

http://www.cnn.com/2004/TECH/biztech/08/04/paperless.hospitals.ap/ 
index.html
---

Jason Barkeloo
President
TouchSmart Publishing
http://www.touchsmart.net
t: 513.225.8765
f: 206.666.4856

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