Doctors Making Digital Leap To Electronic Medical Records

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In a world transformed by digital data, doctors appear unscathed — collecting tons of paper charts and scrawling their prescriptions in a chicken scratch that only nurses and pharmacists can fathom.


Physicians have been slow to convert to electronic record-keeping, even though health care experts say that digital patient records bring greater efficiencies and productivity while improving patient safety.


Many hospitals across the United States have also lagged in adopting these new technologies. Nursing homes and ambulance systems have been the slowest. But a growing number of health providers in the St. Louis area are scrapping their paper charts for electronic records. Some hope to not only cut costs but also to cash in on federal incentives to digitize.


Under last year’s American Recovery and Reinvestment Act, the U.S. Department of Health and Human Services is setting aside about $20 billion in stimulus money: up to $44,000 per physician who meets the government’s criteria for investing in electronic patient records. Eventually, there will be penalties for doctors who fail to switch over. In five or 10 years, experts say, electronic medical records will be swiftly sent between hospitals and medical offices, whose computer systems, as of now, cannot communicate.


“We’re all stumbling toward the future,” said John Short, chief executive of the Clayton-based Rehab Care Group Inc., which owns and operates long term acute-care hospitals and manages therapy programs in skilled nursing facilities, “It’s a tough rollout period. I haven’t heard anyone say it’s easy.” Doctors, nurses and case managers at RehabCare Group are using about 4,000 iPod Touches, iPhones and iPads to enter patient data, triage patients and track medical records. The administration of President Barack Obama says that digital records will not only save the U.S. health care system tens of billions of dollars a year but also improve patient safety. Hard evidence of such savings is slim, but specific studies of hospitals and outpatient care centers have shown that their return on investment can be significant.


A 2006 study of Brigham and Women’s Hospital in Boston — a teaching affiliate of Harvard Medical School — found that over a 10-year period, electronic health records provided net savings of $16.7 million. Other experts say electronic records help prevent costly medication errors due to miscommunication, including misunderstood handwriting.


Medical software on the market includes tools that catch potential drug interactions or inappropriate dosing as well as alerts that highlight patient allergies. In any event, software developers expect a bonanza of medical offices and hospitals to go digital. And the emergence of the iPad — a computer tablet with a large screen — could be the shot in the arm needed for health care providers to invest. At least one local company, ClearPractice LLC, hopes to lead the way for doctors. In late September, the Maryland Heights-based firm rolled out its Nimble system — the first all-purpose medical records application designed specifically for Apple’s iPad.


REDUCING MEDICAL ERRORS About 22 percent of doctors and only 10 percent of hospitals nationwide have converted to digital patient records.


Among local hospital systems, SSM Health Care — which operates St. Mary’s Health Center and six other hospitals in the St. Louis area — was an early bird. SSM has invested about $330 million in electronic records in the past several years at its 15 hospitals in four states. “It was a huge culture change for our caregivers,” said Mike Paasch, vice president and regional chief information officer for SSM, adding that nurses adapted more readily to digital record-keeping than doctors. Beginning in 2006, SSM began installing electronic record systems in its local hospitals — replacing hard copy charts with a single, digital record that includes diagnostic tests and lab results, prescriptions and doctors orders. The records are kept with security controls in SSM’s central data base.


“It was a big change for the physician population to do order entries and many things that proxies had done for them in the past.” Paasch said. “(But) I think for the most part they recognize the value from a patient safety and patient care perspective of having all the information available at any point that they need to get to it.” He said electronic patient records had already resulted in more efficient patient care and fewer medical errors at SSM’s local hospitals.


St. John’s Mercy Medical Center, and its sister hospital in Washington, Mo., have also invested heavily in information technologies and now have fully functional electronic medical records systems, including barcodes to protect patients from receiving wrong medications. Its first medical group offices went live with digital records in early 2008, and its hospitals went live in 2009.


St. John’s Mercy also went live earlier this month with a system that provides online access for patients to view their health records, get test results, e-mail their physicians and make appointments. BJC HealthCare has lagged behind some of its competitors, but is in the process of converting all nine of its hospitals in the area to digital patient records and barcode systems.


BJC’s flagship, Barnes-Jewish Hospital, has a computer system that enables nurses and physicians to directly order medicines and helps minimize potential errors. In September, the hospital began installing a barcode system for medicines. Barnes-Jewish physicians, residents, and interns adapted “very well” to the electronic ordering system, in part because they helped design it, said program manager Pat Mueth. St. Louis University Hospital, which is operated by the Tenet HealthSystem, has also been slow to digitize, but will begin installing electronic health records systems in January. Among skilled nursing operators, the Rehab Group is plunging head first into hand-held devices.


The company has about 300 iPads in the hands of its 19,000 employees and plans to have about 3,000 in use next year in its 29 acute care hospitals, 107 rehabilitation hospitals that it manages, and the therapy programs it runs in 1,100 nursing homes. The firm relies on a “cloud-based” Internet system with software by, a San Francisco firm whose customers rent data storage space.


“You’ve got to view this as a journey, not a destination,” Short said. “Basically, we’re changing the tires on a car that’s going 80 miles per hour.” Boost from iPad Some doctors offices converted to electronic records a decade ago, but those are the exceptions. Software developers have created medical iPhone applications for physicians, but the device’s small screen makes it difficult for them to read X-rays and other documents.


“Doctors themselves are really slow to make decisions, but for the first time they are really looking at switching over,” said Matina Koester, who owns St. Louis-based Digital Partners Inc., which distributes Apple products to businesses. Even so, Koester expects iPad usage to first inundate the pharmaceutical industry, with increased usage by drug sales reps. “I think we’ll see doctor’s offices move to this after the drug companies,” she said. ClearPractice began developing its iPad application six months ago, and tested it for a month in about 20 medical offices.


“Doctors took to it right away with minimal training,” said Joel Andersen, president of ClearPractice. “They’re using it in all facets of their business — at home, in the office, in front of their patients, and in the hospital. They’re finding the product to be quite intuitive.” He said doctors can use their iPads at home to review the day’s progress notes, test results and X-rays, refill prescriptions and send messages.


ClearPractice, a subsidiary of Essence Healthcare, was founded by venture capitalist John Doerr and his brother, Dr. Tom Doerr, a physician and software designer. The firm has about 90 employees, including 35 to 40 software developers and testers in Hyderabad, India. The remainder of its support and training staff is based in Missouri.


ClearPractice’s prime competitors include NextGen Healthcare in Pennsylvania and E Clinical Works of Westborough, Mass. Neither firm has an iPad application yet. Other competitors include Allscripts Healthcare Solutions in Chicago and Epic Systems Corp. in Verona, Wis. For several years, ClearPractice has marketed a Web-based system that allows health care providers to share information between hospitals and outpatient offices, but only about 500 doctors are using this system. The firm’s new iPad application is compatible with this database. The Nimble’s basic functions include reviewing and sending doctor’s reports, tests and imagery; appointment scheduling; billing records; and electronic prescribing. The system is accessible through a Web browser, an iPhone or an iPad. No patient data, such as the doctor’s diagnosis, treatment, or billing records, is stored on the iPad device itself; the iPad is connected via wireless to a data center operated by ClearPractice, and patient data is encrypted when transmitted.


Andersen said a doctor’s clinical support staff can use the device from check-in to checkout — beginning with the screening of patients, taking their vital signs such as blood pressure, capturing the patient’s chief complaint, and recording the patient’s medical history. He said about 70 percent of physicians work within a small practice of fewer than 10 doctors, and the majority of these practices don’t yet have electronic patient records. Traditionally, software vendors have focused on larger medical practices.


“We understand the small practice physician and really have the technology model and price point to really adequately serve the needs of that market,” said Andersen. ClearPractice’s monthly subscription rates run from $99 to $499. “We don’t charge for support staff. We only charge for doctors,” said Andersen, explaining that doctors usually pay for the cost of subscriptions and also supply iPads to their staff. He also said his firm can deploy its product at a rapid pace — without the need to shut down a medical practice. Doctors and their support staff learn the basics from Web training videos, and once the office goes live, they have access to ClearPractice’s technical support staff. “By the end of the year, we should have an additional 500 doctors using the system,” Andersen said.

Source: Oct 17, 2010 (St. Louis Post-Dispatch – McClatchy-Tribune Information Services via COMTEX) —

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