This article first appeared in the St. Louis Beacon, July 20, 2011 - When an athlete limps into an orthopedic surgeon's office for treatment of a swollen ankle these days, he or she is likely to be asked to sit before a computer and use questions and illustrations on a high-definition screen to explain the cause and location of the pain.
After reviewing this patient-created digital record, the doctor examining the ankle might use still more illustrations while discussing the injury and offering a course of treatment. As quickly as one might forward a computer file to a friend, an assistant in the doctor's office might zip the medical record to the athlete's primary-care physician.
No paper. Just digital files.
That's part of the future of health care in Missouri. But the state isn't there yet. At best, digital records can now be shared with ease only among providers who are part of the same health network -- say, the one run by BJC or SSM. But Missouri is laying the groundwork to build a secure network to allow providers across Missouri to share patient data normally shielded by firewalls, passwords and other systems to protect privacy.
Boosting Efficiency
Other states are in various stages of building similar record-sharing systems as a way to cut health costs. This move was initially part of stimulus funding under the Health Information Technology Act, which predates the Affordable Care Act. Federal stimulus program money from the act has accelerated the move toward electronic records.
Missouri Health Connection is the agency responsible for overseeing the development of the state's health information exchange or electronic record-sharing system. The agency has received $13.8 million in federal stimulus money to cover planning and other initial work. It also has entered into contract negotiations with Cerner Co., based in Kansas City, to build Missouri's system. In light of the federal budget debate and uncertainty over the health-reform law, the only uncertainty is how much more money the feds will invest in these systems.
Mindy Mazur, director of public affairs for Missouri Health Connection, adds that linking all the health-care players would help boost efficiency.
"We'll have a system to connect Missouri providers, so that if you live in St. Louis and you have to see a doctor while on vacation in Branson, the doctor there can access the system and get your whole medical history right away."
Cerner's general manager, Dan Schipfer, says the new system would also help trim what consumers and businesses pay for health care.
"First, you can reduce administrative cost by making the records available electronically." he said. "Second, you can decrease redundant diagnostic tests that occur when you don't have access to records of previous test results."
In some ways, hospitals have made this shift possible by moving away from paper data. The Missouri Hospital Association recently issued a study showing that 90 percent of its 145 hospitals have reported turning to electronic records for some patient needs. That shift will make it easier for Cerner to build a statewide record-sharing system, Schipfer says.
Missouri Hospitals Lead The Nation
Some hospitals are making the transition faster than others. A survey released this month by Health & Hospital Networksmentioned six Missouri hospitals as among the most wired in the nation, meaning they are making better than average progress toward use of information technology. The six were Barnes-Jewish Hospital, Saint Luke's Health System, Kansas City; Sisters of Mercy Health System, Chesterfield; Truman Medical Centers, Kansas City: University of Missouri Health Care, Columbia; and Citizens Memorial Healthcare, Bolivar.
Citizens Memorial also stands out as a progressive hospital in a small town. It shifted to an electronic medical record system and eliminated paper records in 2003, says Denni McColm, chief information officer.
"Our vision is for patients to be able to enter anywhere into our continuum of care ... and for physicians and other caregivers to have access to all of the patient's information from across our system."
The result, she said, is that "care is delivered more efficiently and physicians and other caregivers have the information they need to make the best decisions possible for their patients."
Memorial also might be regarded as one of the state's most wireless hospitals. McColm ticks off a range of other developments made possible by shifting to an electronic system.
"We are utilizing video interactive telemedicine to deliver mental-health services to long term care residents," she says. "We are implementing home sleep studies that will be uploaded for analysis by a pulmonologist without patients having to travel from their rural communities to a sleep lab."
Progress In Illinois
Electronic systems are also changing hospital practices in Illinois, says Dave Holland, vice president and chief information officer at Southern Illinois Healthcare, based in Carbondale.
He says that his system has not only shifted away from paper records but that doctors are beginning to use more high-tech devices. About 30 percent of the devices used in the Southern Illinois Healthcare network are mobile, he says. This has allowed more involvement in patient care, Holland says, by making what he calls virtual rounds at hospitals. Typically, a doctor might make rounds in the morning and see patients in the office in the afternoon. Holland says doctors are now able to make virtual rounds several times a day, using iPads and other mobile devices to review patient data, such as lab tests results, nurses' notes and other up-to-date information.
"All of a sudden if blood pressure is spiking, the doctor can be a lot more proactive about the care," Holland said. "This makes for a better life for the clinician and better care for the patient because the doctor is looking in at what's going on with the patient much more often than in the past."
As for electronic medical records, all states apparently hope to have systems in place by 2014. Some say the federal stimulus money was a down payment. But nobody in Missouri or Illinois could say for sure how much more funding will be available to build the networks. The assumption seems to be that incentives to build the system will be available because the shift to digital records is part of an overall federal strategy for cutting health-care costs and improving the delivery of health care.
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
