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High-Tech Charting State Promotes Electronic Medical Records Systems

Posted on: Monday, 4 July 2005, 18:00 CDT

Although Louisiana has gained a reputation for less-than- progressive approaches to business, the bayou state has become a leading-edge proponent of the use of electronic medical records.

Louisiana was the second state to join the eHealth Initiative Foundation's State Health Information Technology Policy Summit Initiative. The program brings state policy officials together with health-care, consumer and business leaders to help improve health care through IT. Health-care leaders will meet in Baton Rouge on July 21 to begin developing a plan to implement the electronic medical records systems.

"We're hoping to push and promote the adoption of electronic records because we know we can reduce errors, improve performance on preventive measures and patient outcomes ... and generate overall savings to the health industry," said Fred Cerise, director of the state Department of Health and Hospitals.

HCA, the nation's largest hospital chain, said its electronic medical administration record system evaluated 7.4 million medication doses in December 2004. Without the system, HCA estimates 2 percent of the medication doses would have been given in error.

Although hospitals and larger providers are moving toward electronic records systems, industry experts say that fewer than one- fourth of Louisiana doctors' practices have moved to electronic medical records.

"It's unusual for physician practices to have the systems," Cerise said. "There are no incentives."

Although physician practices have to pay for the systems up front - the initial cost for the systems can be in the hundreds of thousands of dollars - the benefits go to insurance companies, the state and patients, Cerise said. The doctors also gain from using electronic records, but there is no guarantee physicians will recover their investment.

Making sure practitioners' systems can communicate with each other will help cut health-care costs, Cerise said. Tests won't be repeated because the practices will share patient records.

Cerise hopes to get the incentive payments through the federal Centers for Medicare & Medicaid Services.

Physician practices would receive higher reimbursements so they could invest in electronic medical records systems, Cerise said. There has to be some reward to get people to implement electronic medical recordkeeping.

The Medicaid waiver is just one of the inventive approaches the state is using to move doctors to electronic records and away from paper.

DHH has also launched a pilot program for e-prescribing among doctors in training using a hand-held computer or a personal digital assistant (PDA).

Electronic prescribing reduces medical errors, improves efficiency and helps doctors stick to the preferred drug list. One big advantage is that pharmacists don't have to interpret the doctors' handwriting, Cerise said. Another is that e-prescribing reduces fraud because people can't fill a friend's prescription.

Dr. Tony Sun, medical director of Louisiana Health Care Review Inc., said the pilot program started with the in-house pharmacy at LSU's Earl K. Long Hospital and around 30 residents/physicians. Louisiana Health Care Review, a nonprofit that designs and implements health-care quality improvement programs, is working with DHH.

There are now plans to implement the program in selected physicians practices in Baton Rouge and Shreveport, Sun said. In addition, DHH is in discussions with an insurance company to implement the program statewide.

Sun said about 15 percent of doctors in Louisiana can electronically fax a prescription to a pharmacy, which then prints out a hard copy before filling the prescription.

Right now, almost no one has the capability to e-prescribe, which means that whatever the doctor prescribes shows up in the pharmacy's list of prescriptions to be filled, Sun said.

Electronic interconnectivity is the key to that process, Sun said. Several large pharmacy chains are working together to develop interconnectivity specifications that will establish a standardized electronic link between doctors and pharmacies.

Other information technology initiatives in Louisiana include:

A DHH pilot program that tells health-care providers what treatment or preventive care a diabetic Medicaid patient needs. After a person swipes his or her Medicaid eligibility card, the software lists the tests or procedures recommended, such as blood tests and eye exams. It also lists how often the treatment is needed, when the patient last received the treatment and when the person should be treated again.

Cerise said the "provider decision support tool" will help make sure that patients get the preventive care needed.

In a busy practice, if a patient comes in for one treatment and receives it, it's easy for the provider to overlook the need for other required care, Cerise said. Eventually the tool will be applied to other chronic diseases and even cancer screening.

Ten rural hospitals are using a $1.1 million DHH grant to implement electronic medical records systems in their emergency departments.

The major beneficiary of the systems will be patients, said Mark Chustz, chief executive officer of West Feliciana Parish Hospital. The systems, when in place, will take the provider through a sequence of questions covering all the parameters associated with the illness.

Although doctors already do this, Chustz said, the system helps ensure nothing gets overlooked.

With the system, hospitals will be able to transmit patient records to each other, basically by e-mailing them, Chustz said. The hospitals get an electronic record, so they don't have to store a paper chart for the 10 years required by federal law.

With space at a premium in hospitals, electronic data storage means more room for patients and their treatment, Chustz said. The systems will also allow hospitals to generate a variety of reports detailing everything from how much time passes before a doctor or nurse sees a patient to the exact moment when a potential heart attack victim receives an aspirin.

The latter is one of the quality measures the federal Centers for Medicaid & Medicare Services, which are pushing hard for electronic medical record use, employ in evaluating a hospital, Chustz said. Before the new system, hospital employees had to manually go through the records to check the time the aspirin was given.

The new system will be able to generate that report automatically.

A survey of 4,000 physicians to find out how many use electronic medical records and other health information technology. Louisiana Health Care Review, with help from the Louisiana Academy of Family Physicians and the Louisiana chapter of the American College of Physicians, is doing the survey.

"This information will also assist us in recruiting primary care physician practices that are ready to adopt an electronic medical record in their practice," said Jack Olden, Louisiana Health Care Review director of outpatient programs.

Primary care physicians include doctors in family practice and internal medicine. The survey is part of the Doctor's Office Quality- Information Technology project, a Medicare-sponsored program designed to help primary-care physician offices improve patient care through technology.

Blue Cross and Blue Shield of Louisiana lists its formulary, or the prescription drugs covered by the insurer, through ePocrates. The high-tech tool lets doctors compare the co-payment levels of drugs for their patients and provide the most up-to-date information on dosing and drug interactions before a prescription is written.

Prescription cost information is important because co-pays can vary depending on whether the drug is available in a generic, brand- name, multi-source brand or injectable forms, according to Blue Cross.

Since Blue Cross partnered with e-Pocrates, 1,925 Louisiana health care providers have subscribed to eProcrates, including 917 doctors.

Source: Advocate; Baton Rouge, La.

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