Promise and problems arise as health records go online

Electronic medical records
Dr. John Butler jokes with his patient, Willie Martin, during a visit at the Arden Hills Clinic in Arden Hills, Minn. Wednesday, May 24, 2011. Dr. Butler uses an electronic medical records system with his patients, both at the clinic and remotely.
MPR Photo/Jeffrey Thompson

At the HealthPartners clinic in Arden Hills, Dr. John Butler shows up noticeably empty-handed as he sits down to meet with his patient, Willie Martin. Martin, 70, who has type 2 diabetes, electronically sent his blood sugar level readings before the visit.

"We can look and see how things have been going here," Butler said, as the two peer at the exam room computer screen.

The scene is a view into the future of doctor visits. The federal stimulus and health care laws are pushing medical providers to go electronic as a way to improve patient safety and track health care quality. As the profession is increasingly going online, it's finding both promise and problems.

PROPONENTS TOUT SAFETY, SECURITY BENEFITS

Pediatrician Dr. Trish Scherrer, a specialist in treating very sick children in intensive care, said the safety provided by electronic records is huge. Even two- and three-year-old children can have so many reports in their files, the paper files are taller than they are.

Scherrer said searching those files by hand was daunting, but searching electronic records is a snap. "If I'm looking for the single piece of paper ... it is much, much easier for me to find that electronically then trying to quickly thumb through 18 volumes of charts," Scherrer said.

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Electronic medical records
Dr. Patricia Scherrer is a pedicatric physician at Children's Respiratory and Critical Care Specialists in Minneapolis, Minn.
MPR Photo/Jeffrey Thompson

Some of the systems she uses also alert doctors to potential mistakes such as whether they're ordering too much of a medication, Scherrer said.

"A dose range alert comes up and it says, 'this is way over the suggested dose range for this medication,'" she said.

Despite those benefits there have been concerns about the security about electronic records.

But Dr. Beth Averbeck, an associate medical director for HealthPartners said compared to paper, electronic medical records or EMRs are actually more secure.

"We have the ability in an electronic record to actually track who might've had access to it because all of us have unique sign-on codes," Averbeck said. "Whereas in a paper record it might've sat in a chart room and you don't have that level of security or ability to track who might've had accessed it."

About a week ago, the Department of Health and Human Services proposed a rule that would give patients the right to know who electronically accessed and viewed their protected health information.

STRONG COMMITMENT NEEDED

But moving away from paper files to an electronic health record system requires serious commitment on several levels.

First, they're expensive. Depending on the size of the organization and other factors, estimates range from several million to more than $50 million.

Second, the learning curve can be painful. Installing the system, and training staff can be a long frustrating time, when the staff sees little benefit. There's even a name for the adjustment period — "the valley of despair."

Bob Ainsbury
Bob Ainsbury is vice president of St. Paul-based Lawson Software's health care business.
MPR Photo/Elizabeth Stawicki

That valley can last many months according to Jennifer Lundblad, CEO of Bloomington-based Stratis Health. The non-profit advises rural and under-served communities in Minnesota and North Dakota about electronic health records. Lundblad said putting in these systems means a new routine for every employee in a hospital or doctor's office.

"It's not about plugging in a new technology and turning it on," Lundblad said. "It's about redesigning how you deliver care. We often say that's the 80 percent of the change, 20 percent is the technology."

But even after clinics have these systems, that's not the end of the commitment. They require IT people to maintain and update them — like any computer system. In addition, there's a lack of health IT people to go around. Some estimates put the shortfall nationally at 50,000 workers over the next five years. The National Coordinator for Health Information Technology says a federal $84 million IT workforce program will help fill that gap.

Joe Wivoda of the Duluth-based National Rural Health Resource Center, who's also a health IT consultant, said the workforce program is a good start but the training takes a couple of years and medical clinics need health IT people now.

"The rural hospitals are really having a hard time finding qualified health care information technology people," Wivoda said.

A PATCHWORK OF SYSTEMS

Still, Minnesota overall has one of the highest adoption rates, if not the highest adoption rate of electronic health record systems in the country. By one estimate it's as much as 80 percent. But that doesn't mean all systems are similar.

Some experts estimate there are at least 30 major electronic record systems and the smaller ones are too numerous to count. And Scherrer, the pediatrician, said the variety can be a challenge. Scherrer works at five different hospitals in the Twin Cities and each one has a different medical record system.

Susan Lynch
Susan Lynch, a nurse practitioner, checks over a patient's electronic medical records at a Florida hospital in a file photo. As the profession is increasingly going online, it's finding both promise and problems.
AP Photo/John Raoux

"It's like speaking five different languages," Scherrer said. "Each one can be fun to learn and may not be that difficult. But on a day-to-day basis, you're switching between one language and the other and sometimes you forget which language you're using."

Not only that, none of the five systems she uses can communicate with each other.

Some argue that ensuring electronic systems can talk to each other would save lives. For example, you have a serious allergy to a particular medication and your medical records are on one system in Minneapolis, but you're unconscious in an emergency room in Detroit. It would make sense that the Detroit ER doctors have the ability to access your medical information. But that's many years away.

Bob Ainsbury, vice president of St. Paul-based Lawson Software's health care business, said one reason is that the industry has been based on local, independent practices and hospitals.

"We've come from a disparate community of tens of thousands of care places and over the last 15 years, they've started to aggregate and started to pull together," Ainsbury said. "There is a collection of different systems that have evolved as technology has evolved that are going through a transformation themselves."

EXCHANGES HELP BRIDGE INFORMATION GAP

But while independent systems may not be able to talk to each other directly, public and private groups, including Lawson, are developing so-called health information exchanges. These neutral systems would take medical information in one electronic format, process it securely into another electronic format so that it can be accessed by someone outside the system.

Minnesota just certified its first state exchange with the Community Health Information Collaborative, a Duluth-based nonprofit of 200 health organizations in northeastern Minnesota. It's scheduled to begin in early July.