Hospitals sing the body electronic
Doctors turn to 'paperless charts' and digitized X-rays to track patients' health
Last month, 72-year-old Janet Banks spent several days recovering from a heart attack in the intensive care unit of Legacy Meridian Park Hospital in Tualatin.
Doctors and nurses there monitored the Lake Oswego woman's condition using a 'paperless chart' Ñ a mobile computer that contained all of her medical information, from her vital signs to lab test results to the doctors' latest orders.
Meanwhile, in the hospital's radiology department, Dr. Brian Mahon was studying 'digitized X-rays' of a patient's lungs on his computer screen Ñ images that had been sent over the Internet.
Technology, as these examples show, is changing the way medical care is being delivered, not just in the Portland area, but in hospitals nationwide.
The most widespread technological change involves switching from paper to automated records in which 'all of the relevant clinical information associated with a patient's encounter with the hospital is incorporated into an electronic medical record,' said Matthew Calais, chief information officer for the Legacy Health System.
The switch to automated records ÑÊwhich began in many hospitals in the mid-1990s ÑÊmeans that medical information can be accessed more quickly and is more accurate.
The switch also reduces medical errors and saves on costs that result from those errors, say Calais and other hospital administrators.
Yet, unlike banks, which long ago made electronic transactions commonplace, health care systems have been slow to adopt electronic medical records for a number of reasons, said Dr. William Hersh, chairman of Oregon Health & Science University's Department of Medical Informatics and Clinical Epidemiology.
Among them: expense, confidentiality concerns, added workload for doctors who must learn a new system, and worries by some doctors that their decisions would be monitored and second-guessed.
Still, switching to electronic medical records 'is ultimately what is going to speak to patient safety,' Calais said. 'With today's clinical and medical complexities and
regulatory requirements, hospitals can't operate without the necessary automation.'
Digitizing makes savings
'Digitized X-rays,' used by Legacy's four area hospitals, have been converted from conventional film to electronic images that can be sent through a computer network, said Diane Buelt, Legacy's imaging services director.
'The system serves as our viewer and our storage system,' she said.
Digitized X-rays allow for simultaneous viewing by, for instance, an emergency room doctor, a radiologist and a surgeon.
Images can be sent from hospital to hospital or to doctors' homes in the middle of the night so they don't have to drive to the hospital.
'The diagnosis is as fast as a physician looks at it,' Buelt said.
Another advantage: The images can be magnified or otherwise manipulated. Digitized X-rays also save storage space that hospitals devote to traditional films, Buelt said.
'We have very strict guidelines on how we protect the information,' she said. 'Only authorized personnel have passwords and other codes to access the images.'
And digitized X-rays will save from 40 percent to 80 percent of the cost of film and processing.
'This is the way that all of health care is going, toward electronic imaging,' Buelt said.
The costs of conversion
The mobile computers in Meridian Park's intensive care units allow the staff to move from bedside to bedside, easily looking up information for each patient.
The computers have virtually replaced paper records in the hospital's intensive care unit.
'The information is updated continuously,' said critical care supervisor Carol Palmer. 'They are much more efficient and safer for patients.'
Legacy began converting to electronic medical records in 1997, Calais said. About 90 percent of the medical information in its four hospitals is now automated, Calais said. The system should be fully automated by 2004.
'It required a significant amount of training, behavioral changes and a great deal of capital,' Calais said.
Dick Gibson, the Providence Health System's medical director for information systems, estimates that Providence spent $50 million to $70 million to convert its seven hospitals to an electronic medical records system over the last seven years.
Though the hospitals still have some changes to make, all Providence physicians' offices are 'completely electronic,' he said.
Automated records save on overtime for nurses, who don't have to spend time writing information in patients' charts.
They also reduce the chance that doctors will prescribe the wrong medicine, resulting in an 'adverse drug event,' Gibson said.
Kaiser Permanente Northwest may be furthest along in converting to electronic records, a process it began in 1994.
Kaiser no longer keeps paper records for any of its member patients, said Dr. Homer Chin, Kaiser's assistant regional medical director for clinical information systems.
'All of a patient's information is electronically entered,' he said. 'All the medications you've taken, all your lab work, doctors you've seen, results of radiology tests, an advanced directive, all would be in the system.'
Besides reducing the chance of making errors, 'a huge advantage is that we're able to do population care,' Chin said. 'We can identify all patients with diabetes or all who have high cholesterol. It's much easier to work with them.'
Automated systems raise several concerns, including privacy and security of patients' medical records and monitoring doctors' decisions. All systems have a complex system of safeguards that include passwords and codes for appropriate staff.
A more difficult policy to implement has been 'physician order entry,' in which doctors enter medical orders into the computer instead of writing them out.
'It sounds as if doctors just need to do it, but it goes much deeper than that,' Calais said. 'One of the reasons is that it takes more time for the doctor to enter orders into a computer than to write it down on a piece of paper.'
OHSU's Hersh said about 17 percent of primary care doctors in the United States have converted to electronic medical records.
That puts the United States 'near the bottom of the list' when compared to physicians in the United Kingdom, where the figure is 50 percent. It is higher in Sweden and Norway.
Hersh said health care purchasers Ñ such as businesses that provide their employees with health insurance Ñ will drive the demand for more efficient care, including automated records.
'The benefits (of electronic medical records) is undeniable,' he said. 'It won't be without bumps. But health care needs to be more accountable.'