A critical condition
Walking out the front door with the family dog on a leash, Alisoun Moore slipped on the front stoop when the dog unexpectedly bolted inside. She fell and broke her wrist, entering not only a world of hurt but also the crazy world of medical information systems.
She went to the local emergency room and learned she needed surgery, but when she went to the orthopedist, she discovered that the hospital had never sent the referral to the physician. So she went to her primary physician for the referral and was surprised to see that her doctor was still using a fax machine instead of email.
At the time, Moore was Maryland’s chief information officer, and she was shocked by the archaic nature of medical information systems. “In terms of technology of care, like MRIs and scans, medicine has come a long way,” she says. “But in terms of process, the practice is essentially the same as the early part of the 20th century: Paper-based files and little information easily transmitted between the physician and the hospital. I was taken aback by the lack of use of technology.”
Today, as the director of health and human services for Los Angeles-based Northrop Grumman’s state and local government information technology communications division, Moore’s primary goal is to build systems that ease the transfer of information among the various components of the health care process and heal what she calls a “fragmented system.” It is a cause that many others are taking up as health care costs eat up greater amounts of public funds and preventable medical mistakes claim more lives. “This is something that we’ve got to fix,” she says. “There are lots of improvements that we have to make. Lots and lots.”
Safe and reliable records?
As health care costs are skyrocketing, administrative costs of medical care for public clinics and hospitals grab more precious revenue. At the same time, while local governments have made significant strides in integrating information technology into other operations, enhancements in the medical sectors have lagged. “Chief technology officers in communities can’t understand why they can’t make medical operations more efficient,” says Alan Shark, executive director of the Washington-based Public Technology Institute. “They develop bigger and better equipment for patients, but do much less to improve record management.”
In general, the basic problem is that records have been slow to move from paper to computer. Even then, computer systems in hospitals and doctors’ offices often are incompatible, which makes information interchange difficult and unreliable. “Records are sloppy and hard to transfer,” Shark says. “Hospitals feel like they are in a time machine. They constantly fill out pieces of paper that go nowhere. We need to move to a safer, more reliable environment.”
Recent studies have found that current medical information technology is anything but safe and reliable, and that affects lives and finances in ways that few people realize. According to the Washington-based National Academy of Sciences’ Institute of Medicine, up to 100,000 deaths each year are attributable to preventable medical errors, such as prescribing medicine to a patient who previously has shown an allergic reaction. Improper medication, the organization has found, accounts for 7,000 unnecessary deaths each year. The group estimates that medical errors cost the nation more than $1 billion in avoidable hospital bills and nearly 41 million workdays, resulting in the loss of $11.5 billion for American businesses.
Research by New York-based The Commonwealth Fund, a private health care-related foundation, points out “disturbingly high rates of medical errors” that plague the U.S. health system. In its 2005 National Scorecard of Health System Performance, a study of chronically ill adults in the United States, almost 25 percent reported that their test results or medical records were not available at the time of their appointment. And, 20 percent indicated that a doctor had ordered a test that had already been done in the past two years. “Frequent error, miscommunication and wasted resources from duplicate tests, delays and conflicting information are common problems in the health systems,” said Karen Davis, president of The Commonwealth Fund in a statement. She argued that the findings “make a compelling case for implementing interventions that we know will make a difference, including electronic medical records and computerized systems for physical ordering of prescription drugs.”
Part of the difficulty in converting to an electronic medical record system is proving that the changes actually will save money and improve care, says Scott Schumaker, chief scientist at Chicago-based Initiate Systems. “Typically, hospitals track visits from a patient as discrete events,” he says. “If you are sick in a hospital and come back a year later, they would rarely link to an old record.”
Rx for the cure
Hennepin County, Minn., has committed $65 million over six years to convert its entire medical system to an integrated network. “This is the most exciting development since I’ve been on the board,” says Randy Johnson, commission chair and county commission member for 30 years.
Hennepin rolled out the new system in late 2007 at the Hennepin County Medical Center, and the implementation has been “extremely successful,” Johnson says. Every interaction in the county medical system now is entered into one computer system. That means that all hospitals, doctors and health officials have a common language. A patient can receive treatment from a primary care physician, then from a specialist, and the information is available immediately for either physician. “It’s also an expert system,” he says. “If a drug is prescribed for a patient, there is an alert check if there is drug interaction with something else the person is on.”
The impetus for the new system is a Minnesota law that requires a statewide electronic-based medical system by 2012. While some doctors who had to convert their own records systems have resisted the conversion, hospital administrators have strongly supported it by only accepting doctors who are trained on the new system.
To those who argue that the system might invade an individual’s right to privacy, Johnson says the opposite: that electronic systems are better for preserving privacy. In a paper-based system, it is next to impossible to track who has looked at a file for the wrong reasons, he says. But, the computer keeps a record of who accesses a file each time it is called up, and access is strictly regulated.
As a result of the new system, Johnson expects more efficiency, improved billing and fewer problems created by handwritten charts and lost x-rays. He estimates the new network will pay for itself through cost savings over seven to eight years. “There is always a concern that a doctor doesn’t spend more time with a patient,” he says. “This system doesn’t give them more time, but it makes the time available more productive. The doctor isn’t thumbing through paper charts, looking for the key piece of data that has been misfiled.”
In the central Appalachian area near the Tennessee and Virginia border, Liesa Jenkins has been leading a concerted effort to integrate technology into medical systems. Jenkins is the executive director of CareSpark, a Regional Health Information Organization (RHIO) that is one of about 150 such organizations around the country working under a federal initiative to promote better medical information exchange. Two public health clinics are among the CareSpark network of hospitals and physicians that are converting records across the region that includes 17 counties in two states, 18 private hospitals and 1,200 physicians and serves more than 750,000 residents.
According to the 2008 “Fifth Annual Survey of Health Information Exchange at the State and Local Levels,” by Washington-based eHealth Initiative, RHIOs report that electronic data exchange has reduced health care costs and medication errors and generally improved patient outcomes. The 130 organizations that responded to the survey also reported a positive financial return on their investment for their stakeholders.
CareSpark has focused on four areas of technology where it sees the possibility of significant progress. It will work to build an identification system so that different facilities’ records can be linked to the same patient; records will be centrally indexed so they can be retrieved by providers; all documents will be located at the same repository; and, eventually all the records will be viewable at any of the participating facilities.
The project — which is funded by participating states, physicians and hospitals, and by the U.S. Department of Health and Human Services — will cost $12 million over the next three years. “The cost of health care will not be driven down in the short term,” Jenkins says. “But, if the dollars spent are used effectively, it will have an impact.”
— Robert Barkin is a Bethesda, Md.-based freelance writer.