No more pushing paper with electronic medical records

August 03, 2009|By TIFFANY ARNOLD

Accessing a patient record at Dr. Mahesh Krishnamoorthy's office used to mean sifting through 3,000 paper folders.

And if part of that record was lost, Krishnamoorthy said, it could have meant a longer wait time in the lobby until somebody found it. Or worse, the doctor would have incomplete information at the time of the patient's appointment.

"In medicine, inadequate, incomplete information is fraught with dangerous risks for the patient," Krishnamoorthy said.

Risks could range from missed appointments and duplicate tests to bodily injury and death, he said.

Today, Krishnamoorthy's office, Robinwood Internal Medicine, uses an electronic system to manage its medical records.

"Right now, all I carry is a single laptop with access to all 3,000," Krishnamoorthy said.

Local doctors who use electronic medical record systems - referred to as EMRs - said e-records offer more than the promise of efficiency. Going digital contributes to patient safety, said Carey Leverett, vice president of information services for Washington County Health System.


Krishnamoorthy said EMRs offer several layers of passwords and encryptions to protect patients data. So if someone steals his laptop? "Information does not reside on the system," Krishnamoorthy said.

With EMRs the data resides on a separate server and is only available on-demand, Krishnamoorthy said.

"This is infinitely more secure than paper records, which are lying in offices where anyone can barge in and open anybody's record," he said.

Benefits of EMR

Leverett said when data is entered in real time by doctors it reduces the chance for error. It could also cut down on wait times due to staffers hunting down paper documents, which might be lost.

Dr. Matthew Hahn, a practitioner in Hancock, said EMRs could do things like automatically check for medicine interactions or remind him if patients are due for routine checkups such as yearly mammograms.

He elaborated on the mammogram example.

"Let's say a woman didn't come to see me for three years," Hahn said, "I had no way of knowing. Then, when the patient did come, very frequently (staff members) forgot to update her information. But in the computer system I developed, we can run that search every couple of weeks."

Hahn also gave allergic reactions to certain medicines as an example.

"If a patient is on 20 medications and there's some arcane interaction with the 21st, I might add, we're just human," Hahn said. "There are true limits, and ... a computer will run that check for me and give me a notice."

Without an e-record system, Krishnamoorthy said a doctor with thousands of records might have had to rely on memory - which is never 100 percent.

"You're expecting a physician to know every piece of detail and that's a very high standard," Krishnamoorthy said.

A steep hurdle: cost

Washington County Hospital operates on a part-digital, part-paper system and handles roughly 550,000 patient records, Leverett said.

Upgrading the hospital's current system will cost more than $5 million over the next three years.

He said the hospital plans to use federal stimulus money to help pay for the cost of going totally digital. But in order to be eligible for the stimulus money, health care providers have to meet certain criteria.

Leverett said the hospital hopes to meet this criteria by 2011.

The federal government has earmarked $19 billion to help health care providers make the switch to computerized medical records, as part of President Obama's push for health care reform. The act enables health care providers to apply for grants to implement e-record keeping, which can be costly.

"Cost is a barrier for a lot of physicians," Leverett said.

How some doctors are handling costs

Hahn said cost is the reason he, along with a fellow doctor and two computer programers decided to create their own EMR system.

"After three or four years, I became convinced that with a paper system, we really had no good means of insuring quality of care or any good way to check for errors," Hahn said.

But the prices for computerized systems he found were in the $200,000 to $500,000 range. So in 2004, he helped develop his own system.

"The model was this paper record I was using," Hahn said. "Taking the good parts of that, exploding the function a thousand times better so that the limits of paper would go away."

Hahn said his EMR system, which he's using at his own practice, is still in development, but costs roughly $3,000 to $4,000 per year, per physician.

Dr. Krishnamoorthy said his office is hoping to use federal money to upgrade its e-records system. As with computer software such as Windows, there are updates and newer versions of EMR systems.

Krishnamoorthy said that while keeping pace with changing technology can be costly and can be like following a moving target, "It's in the best interest of the patients that you move the ball forward."

"We want to use technology so that it's less intrusive, so that yesterday's patient care remains yesterday's patient care," Krishnamoorthy said.

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