Electronic medical records offer promise of better patient care at lower cost
This article first appeared in the St. Louis Beacon, Dec. 8, 2009 - More than a year ago, Dr. Jay Moore, an internist and pediatrician at the SSM St. Charles Clinic Medical Group in Wentzville, became the first SSM physician's office to shift to electronic health records.
That move might not seem like a big deal, but hospitals and physicians say it's the beginning of a major step in health-care reform, one that will improve patient care and lower medical costs.
SSM Health Care was the first area health system to embrace this cutting-edge technology in patient record-keeping across all its facilities and doctors' offices. The change is spreading to other hospital systems as well. Patients may notice it when a nurse shows up at the bed with a computer on wheels. Rather than asking questions, the nurse might simply verify what she already knows -- what medication the patient is taking, results of the last a1c test for diabetes, the recent CT scan -- because the information pops up instantly on the nurse's computer. No more waiting for paper charts to build a picture of the patient's medical history. It's already there on the screen. That's the essence of electronic medical records.
"The bottom line is improved patient care," says Dr. Richard Vaughn, medical director for SSM's electronic records system.
Vaughn says SSM decided to shift "way ahead of the federal high tech bill." He's referring to the health information technology component of the American Recovery and Reinvestment Act, commonly known as federal stimulus money. The health component sets aside $19 billion to encourage hospitals and physicians' offices to speed up their use of electronic health records. Physicians' offices can get about $44,000 if they computerize their medical records, and hospitals can get several million each for doing so. The incentive payments will be available starting in 2011 and end in 2015, with higher payments to hospitals and doctors' offices that convert early on. Hospitals and doctors' offices that have not converted by 2016 may be penalized with lower federal reimbursements.
Lower costs, better care?
These incentives illustrate how important the federal government considers the potential savings using electronic records. Some studies have projected savings of as much as $100 billion a year. Meanwhile, the New York Times recently reported on a new study, led by Dr. Ashish K. Jha of the Harvard School of Public Health, showing that the benefits of computerized health records -- better care and lower costs -- have not quite materialized in hospitals that use them. Even so, as the Times noted, there is consensus that the conversion to electronic records will improve patient care and lower medical costs.
Vaughn says SSM's project has been successful, producing changes that otherwise might not have occurred. For example, the system automatically cross-checks medications, diagnoses lab results and even suggests potential changes in treatment.
"We have seen a decrease in some types of medication errors," he says. "And we have a comprehensive inpatient and outpatient information in a single database available to our caregivers any time they need information about a patient."
On the care side, he cites an example of a patient arriving at a SSM emergency room, acutely ill, unable to communicate effectively, experiencing lots of stress and having impaired memory. In the past, the patient's medical records wouldn't be available. But the new system gives doctors and nurses immediate access to the patient's medical history.
"You may find something that completely changes the way you think about the patient, such as knowing that the patient has had a previous heart attack or has a major problem with a kidney," Vaughn says. "This information can help you move faster and allows you to take care of the patient quicker."
On the cost side, he says electronic records can help hospitals and doctors avoid repeating tests that already have been done.
"The cost factor is really important because the health-care system in the United States is rapidly outstripping our ability to pay," Vaughn says. "If you look at the number of CT scans we are doing, compared to 10 years ago, the number continues to increase."
This happens, he says, because doctors repeat tests when they are working under time pressure and can't find information quickly about CT scans, blood tests and other treatment and don't have time to call hospitals to find the information. Assuming the patient is being treated at an SSM facility, the information can be fetched quickly from the patient's computerized records.
Paper records on way out
In addition, Vaughn says, the system prevents patients from getting treatment that might do more harm than good. An example, he says, is an unnecessary X-ray, adding to the potential harm of lifelong exposure to radiation.
Moore, the internist-pediatrician at SSM's St. Charles facility, says he has seen plenty of benefits since adopting electronic records.
"The biggest advantage is the ability to share information between different offices," Moore says. "You know more about the patient when he walks in the door."
How safe are the records? Both physicians say SSM has put many systems in place to protect patient privacy and prevent outsiders from tampering.
"It's something we take very seriously," Vaughn says. "There's potential (for the electronic system) to be safer than the paper system. It can tell who has been in the system, when and what exactly they looked at. We have a full security team in place. The system has password protection, and it automatically logs off at a certain point" if users forget to log off.
The system also is helpful to patients in making appointments with doctors, reviewing their own health records and refilling prescriptions, Moore says.
Other major hospitals also are at work on electronic health records. St. John's Mercy has electronic records systems at its St. Louis County hospital and its Washington, Mo., hospital. BJC also is in varying stages of implementing electronic health records.
Health-care reform legislation may not be a sure thing, but electronic health records are all but a done deal. The $19 billion carrot that the government is dangling at hospitals and doctors' offices might be enough incentive to persuade them to abandon the costly paper trail.