How electronic medical records are improving an outdated system
Once upon a time, to find a book at the library you had to shuffle through drawers of alphabetically listed cards. To check out at the grocery store, the clerk entered every price manually. Identification wristbands at the hospital had your name written on them in pen or marker. There were no bar codes.
Now, the slowpoke paying with cash holds up the line at the store, and there is no talking your way out of paying up for that Netflix DVD you lost—you’ve already been charged for it. Digital swipes and electronic databases keep track of it all. But, that’s not quite the case with our healthcare system.
Like many an industry before it, healthcare is in a weird state of transition and disarray, as our country slowly shifts from paper to electronic medical records in an attempt to streamline the system. President Obama’s stimulus bill, “The American Recovery and Reinvestment Act of 2009,” included $20 billion to reimburse physicians who adopt electronic health records.
“I think there are two primary reasons for the push,” says Stephen Lieber, CEO of Healthcare Information Management Systems Society (HIMSS). HIMSS is a Chicago-based nonprofit organization that hosts an international conference and exhibition every year on healthcare information technology. “They’re the same reasons why it will help patients and the American society in general. The issues are cost and quality.”
Put delicately, healthcare in the United States has simply gotten too expensive, and the quality of care is below par among other nations.
The Organization for Economic Cooperation and Development (OECD) is an international organization that promotes policies for the improvement of global economic and social well-being. Its 34 members mostly include developed countries, such as France and Japan. According to data from the OECD, the United States spends the most money on medical care per person but has a lower life expectancy and fewer doctor visits per year than average. In 2006, the United States had the highest infant mortality rate compared to Canada, France, Germany, Japan and the United Kingdom. While the debate is heated and rampant on what to do about stateside healthcare, there is no question that the system is flawed.
“What we have to do is find ways to make the delivery of healthcare more efficient,” Lieber says. Making records electronic is a way that the government and the private healthcare sector are trying to do that.
One way electronic records are supposed to lower costs and improve quality of care is by reducing human error. “The most obvious example of that is the elimination of duplicate services or tests,” says Lieber. Though data entry still poses a risk of a clerk making a mistake.
The current healthcare system often forces patients to order and pay for copies of their medical records and lug them from doctor to doctor. “This happens all the time,” says Lieber, “Tests that were performed hours before get repeated because those results are not available to the next practitioner.” Besides creating unnecessary costs, not having a patient’s record can lead to misdiagnosis or inappropriate treatment. “The lack of information is a tremendous contributor to medical error,” states Lieber. An electronic system makes the transfer of patient records faster and cheaper, leading to better communication among health professionals, fewer mistakes and better patient care.
Karen Scalise, a mother and operations manager of Akoya Capital, a Chicago-based merchant bank, recently experienced the frustrations of navigating a nonelectronic medical record system. It took seven weeks after a CT scan for anyone to realize that her father—who had been declared cancer free last January after battling it the past two and a half years—had stage 4 recurring metastatic lung cancer that had spread to his liver. “I called the doctor to find out: Was this a breakdown at the hospital? Was this a breakdown in the electronic medical reporting? What happened?” Scalise relates.
After the incident, Scalise and her family decided to switch oncologists. She ran back and forth between her father’s doctors for the next four days to gather his medical records. “Not every record can be [found in] one department. You have to go through multiple channels of people to get what you need. We received paper records, disk imaging records . . .” Luckily, she had a friend who worked in the hospital to help her navigate the process. “If somebody were doing this on their own, they would go crazy,” Scalise states. She now is convinced that medical records should definitely be electronic so that they can be easily shared among doctors and hospitals. “When you’re burdened with the news of a sick family member, or even yourself, that’s just another step in the process that you don’t want to handle.”
But what about the security risk? With the threat of identity theft and hackers, many people fear putting their personal information into an electronic system, says Andy Salmen, who works in business development at Healthcare Information Services, a Chicago-based company.
“If someone wanted to steal your medical records, it would be easier to throw a brick through your doctor’s office window than to steal them electronically,” he says.
Electronic records are heavily guarded with high-tech security systems. Salmen and Lieber both agree that while the consequences of an electronic security breach are farther reaching, it is much less likely.
The bigger obstacles to switching to an electronic system are the up-front cost to physicians and the fact that some doctors don’t want to change the way in which they document information. It costs about $30,000–$70,000 for a physician to switch to an electronic system, says Lieber. “This is not inexpensive.” And because of the highly regulated nature of healthcare reimbursement, doctors cannot raise their costs of treatment to get that money back, he explains. But, electronic records can allow doctors to treat a higher patient volume and spend more time with their patients, says Salmen—garnering more revenue, thereby offsetting the cost of the change and improving quality of care. Not to mention, if there is a natural disaster, your records are safe, he says.
“There’s no question about it; the benefits outweigh the risks,” Lieber says.
The medical possibilities with an electronic healthcare system are great. “Personalized medicine is becoming more of a reality,” explains Lieber. Recently, healthcare technology has been able to make individualized treatment recommendations. Based on the patient’s medical record, an electronic system might suggest radiation over chemotherapy to treat cancer, for example.
In theory, it makes sense. The benefits are obvious. But, does the machine work if everyone is not on board? Before electronic medical records can truly improve healthcare, the system needs to be more standardized and widespread.
“Your phone is a different product than the one I’m using; you may even be on a completely different network, but we are able to communicate with each other seamlessly,” says Lieber. “Unfortunately, healthcare technology has not historically worked that way.”
OK, so it’s not perfect. But, we’re getting there.
Published in Chicago Health Winter 2012