An electronic prescription for the healthcare system
Wednesday, June 24th, 2009
By: Taunya English
tenglish@whyy.org
President Obama is betting big on information technology. The plan is to use electronic medical records to prevent costly errors, reduce paperwork and better track what works to keep people healthy. But less than 20 percent of U.S. doctors and hospitals use e-records now. So Congress has set aside $19 billion to encourage others to go digital.
Listen:
Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.
Dr. Jean Stretton carries a laptop from one exam room to the next, and has instant access to her patients' medical history and test results. All that information should be available in a paper chart. But paper gets lost in the shuffle. And sometimes doctors forget to review what is written down. Dr. Stretton says an electronic prescribing system double checks her work.
Stretton: I'm less likely to make mistakes, if I start to order amoxicillin and that person is allergic to penicillin it shows up right away as a red flag.
Stretton leads Gateway Medical Associates. Three years ago, the practice was drowning in paperwork. These days prescriptions go from Stretton's laptop straight to the pharmacy. When a patient calls in, questions are entered directly into a digital file. There's no need to go find a chart, or attach a sticky note.
Stretton says her patients do worry, though, about privacy, and the security of their medical data.
Stretton: If my laptop would be stolen, it has no information on it; all the information is stored on the server.
When someone peeks into a paper file, there's no way to know. When an electronic file is opened, usually there's a digital record of the breach.
Stretton likes to tell the Hurricane Katrina story to illustrate the other advantages.
Stretton: The doctors who had electronic systems that were backed up in other states, they still had their records. The ones that had paper records, people lost what treatments they had gotten for their cancer, their records were lost.
The practice has saved enough on paperwork to earn back its initial half-million dollar investment, and Stretton expects the system to keep paying off.
Stretton: One of the things we knew is that in the future doctors would be paid according to giving good care to their patients not just according to how many people walked in and out the door.
The Medicaid and Medicare programs will soon pay bonuses to providers who prove they're "meaningful" users of electronic records, and the Obama administration is drafting a policy to figure out who will qualify.
Todd Park analyzes health policy at the Center for American Progress. He says estimates on the potential cost savings of electronic records range from "nearly nothing" to $80 billion a year.
Park: Health IT by itself, right, doesn't cut cost. Health IT by itself doesn't put hands on people and make them better. It's what health IT is used to do that matters.
At an expo in Harrisburg, tech salesman Patrick Kenny demonstrates. He says doctors can sort through thousands of patient records quickly to figure out who's had their flu shots and or who's missed a mammogram, or even chart a year's worth of cholesterol tests for a single patient.
Kenny: And I can graph that lab over time, so if there are multiple labs, I can see if that patient is doing better or doing worse, and once again all that's available with the click of a button.
Experts warn that health IT can't drive down the cost of care unless more providers digitize their data, link with one another – and then use that information to guide care decisions. Greencastle Consulting helps hospitals make the digital switch, but founder Jacob Kretzing says lots of providers are hesitating.
Kretzing: You may have one physician who's kind of leery to provide that information about the patient because there's the fear that I may lose that patient if another doctor has access to that information.
Some say it will take more than the federal program to push providers past their inertia, and many expect states to step in with their own incentives to nudge doctors and hospitals into the digital age.
Dr Stretton is my physician. The entire practice uses this system so when I go to a different MD every one has instant access to my records , which reduces likelihood of error and saves time both for the MD ans for me. I think it is great.
For instance, the MD can view my HA1C over time and see trends or print out lab reports for me. The system is very efficient, now that all of the staff are comfortable with the program. I went to another physician not part of Gateway Medical yesterday and could not believe that they were still doing everything manually.
Very disappointed in this sugary sweet portrayal of EHR's. I am an internist in a small practice in Delaware and still use paper charts. I do believe that EHR's are necessary and ultimately an improvement, but I am certainly not naive enough to believe that it will save me either money or time. Even the incentives currently proposed will only offset my out of pocket costs. I also believe that the data I will be so meticullously gathering will ultimately be used against me in so called pay for performance schemes. Say I need to document that 90% of my female patients 40 and older get a mamogram this year, but perhaps I have a significant number of elderly women who have chosen to no longer undergo cancer screening, or say my patients don't go because of the out of pocket cost, well then I will be denied pay for choices out of my control. Additionally, these systems are touted as promoting communication, but yet all the different systems out there are not currently capable of icommunicating with each other. And patients aren't actually too pleased with a doctor that spends their visit with her nose burried in a lap top. What about that communication? So, its not inertia thats holding me back, its the prohibitive cost, the time it takes to get the system up and running (our IT person suggested we only schedule half our usual patient load the first several months of using an EHR) and also what I anticipate losing in the exam room — the ability to give my patient my undivided attention with out hunting and pecking for appropriate check boxes on a computer screen.