July 29, 2008

Medical Records Go High-Tech, Linking Doctors, Hospitals

When a 34-year-old man showed up in the emergency room at UPMC St. Margaret complaining of excruciating lower back pain and asking for painkillers, the attending physician looked up the man's records on a portable computer.

The device gave Dr. Timothy VanFleet instant access to the man's complete medical records, including a visit three days before to a doctor's office, where he was prescribed 60 tablets of Percocet, a powerful narcotic.

"Years ago, we would have never been able to see what someone was prescribed in a doctor's office," said VanFleet, who also is director of emergency medicine at Magee-Womens Hospital in Oakland. "There was a big separation between the hospital and doctors' offices."

If VanFleet was able to stop the man's attempt to get drugs, it's because of the latest incarnation of the medical record -- an emerging technology that has allowed doctors to replace scribbled paper records with slick, electronic versions.

The sharing of electronic medical records among hospitals and doctors' offices is perhaps the most eagerly awaited development since doctors started using computers to prescribe drugs.

At the University of Pittsburgh Medical Center, a doctor in Oakland can view a CT scan taken miles away in Bedford. And an emergency room doctor can look at charts of an unconscious patient who has been treated before at UPMC.

"It's just making it easier for people at the hospitals to do the right thing," said Dr. Dan Martich, a critical care doctor turned computer guru who is overseeing UPMC's electronic medical record initiative at a cost of about $225 million a year. That includes an $84 million partnership with a company called dbMotion that is linking UPMC's inpatient and outpatient computer records.

"It's a young field, it's a very young field. We're helping define it, frankly, at UPMC," Martich said.

UPMC's goal is to enable computers at its 19 hospitals to talk with computers at the network's 400 outpatient sites. It could be three years before everyone is connected.

If giants such as UPMC are ahead of the game, the rest of the nation has a lot of catching up to do.

A national survey published last month in The New England Journal of Medicine found that fewer than one in five doctors in the United States are using electronic records.

The survey of 2,758 doctors found only 4 percent of doctors nationwide reported having a fully functional system. Another 13 percent said they had a basic electronic medical record system.

The biggest barrier is cost, said lead author Catherine DesRoches of the Massachusetts General Hospital's Institute for Health Policy in Boston.

"There's a lot of uncertainty about the return they would get on that investment," DesRoches said.

Doctors also question their ability to select, install and implement a system that meets their needs, she said.

But there is consensus that electronic medical records help improve quality of care, DesRoches said. That was enough to compel the federal government to champion the cause of computerized health care.

Last month, the U.S. Department of Health and Human Services picked Pittsburgh as one of 12 cities nationwide where doctors in small practices will receive cash payments for using electronic health records to improve quality of care. Earlier this month, the Senate passed a bill that requires doctors who treat Medicare patients to move toward electronic prescribing -- using computers to supply prescriptions, instead of traditional paper.

Such steps are necessary to help eliminate preventable errors, experts say.

UPMC's system, for example, provides warnings about inappropriate prescriptions, drugs with similar names, allergies and abnormal test results, among other things.

"Every time someone says it's a technology project, I try to correct them. It is not. It's about quality and safety of patient care," Martich said.

Yet the technical aspect can be a barrier to doctors handling many patient-related issues.

It took 18 months of planning for doctors at Children's Community Pediatrics to begin an electronic medical record system. Only eight of the 28 practices have gone live with the system, and the rollout is expected to take another two years.

"One of the fears is change," said Dr. David Wolfson, medical director at the pediatrics network, considered the largest in the region. "Physicians are creatures of habit, and paper charts are something we are very accustomed to. It's something you can hold in your hand, and you can thumb through it."

Yet Wolfson can't argue with advantages that paper records never offered: If one of his patients visits the Children's Hospital emergency room, it will show up on electronic records at his Cranberry and Squirrel Hill offices.

The practices plan to computerize everything from scheduling and ordering laboratory tests to tracking vital signs and writing notes about patients' appointments. The system checks prescription dosages and gives reminders about needed vaccines or screenings for diabetic patients.

"It's all about patient safety and accuracy," said Dr. Grant Shevchik, whose Level Green practice is owned by UPMC. "I believe that in the future patients will pick their doctors based on their ability to have electronic medical records."

VanFleet, who has practiced emergency medicine for 23 years, said he initially was hesitant about embracing an electronic system. Once he began using it, he quickly became a supporter.

Patients are the winners, he said, especially when they have several doctors such as a cardiologist and pulmonologist who prescribe drugs without communicating with each other.

"When they come in, some patients know they're taking a blue pill or a brown pill, but they often don't know their names," he said. "They don't remember their allergies. We've found allergy information in the office records that are not in the inpatient records."