Group Health to Launch Records System Here

By Ripley, Richard

Group Health Cooperative says it plans to launch a new electronic medical records system at one of its clinics here Sept. 19, then start up the system Oct. 24 at its three other Spokane-area clinics and its Coeur d’Alene clinic.

The health maintenance organization says the EpicCare system will give its doctors the capability to order prescriptions, tests, and the like internally or online and will provide its patients with better information on their personal Group Health Web sites, including results from their latest medical tests.

Even though Group Health has had a member-oriented Web-based system for some time, its doctors, when prescribing medications, “still had to pull out a prescription pad, write on it, put the right codes on it, then hope that data-entry people enter the right codes,” says Dr. Thomas P. Schaaf, the Seattle-based HMO’s assistant district medical director for Eastern Washington and North Idaho.

While handwritten prescriptions can be illegible, an electronic order “is clear, it’s legible, it’s associated (in the medical record) with the diagnosis, it goes directly to the pharmacy, so when the patient gets to the pharmacy, hopefully the prescription is ready,” Schaaf says.

The order-entry system includes druginteraction prompts that ask the physician such things as whether a patient is allergic to a drug or whether the physician really wants to prescribe an anti- inflammatory to someone who’s on a blood thinner, Schaaf says. He notes that such combinations can cause problems.

With the launch of the system, the HMO will have a computer in every exam room, so the physician, patient, and family member or other caregiver, if one is present, can participate as the physician writes notes about the examination, Schaaf says. Group Health’s doctors are being trained to engage the patient in conversation as they write such notes, which might jog the patient’s memory so he or she will provide additional information or clarify points, he says.

“Everyone looks at the record together,” Schaaf says. “We’re improving in a way that gives a patient more autonomy.”

The system enables the HMO to print an after-visit summary for the patient, which the patient can take home, making it easier for a patient to remember what’s been said and to comprehend a doctor’s diagnosis or explanation, Schaaf says.

Also, he says, “It’s linked into the Healthwise database, which will provide additional information to the patient” at the click of a mouse.

Inland Northwest Health Services, of Spokane, has developed a 32hospital regional electronic medical system, with which Group Health has some links, and Schaaf says that system gives practitioners quick access to the results of “anything (that occurred with the patient) in an INHS-serviced facility in the last eight to 10 years.” With EpicCare, which is made by Epic Systems Inc., of Madison, Wis., Group Health will be able to “bring continuity to outpatient arena and perfect physician-order entry,” he says.

“INHS has an outpatient module, but not many places have implemented it,” Schaaf says. “They’ve experimented with it. We’ve taken it to a very high level.”

Schaaf claims the system will eliminate the need for doctors to do dictation after exams, making documentation easier, and will eliminate transcription errors and help reduce medical and dosage errors.

Doctors will have secure inboxes that will keep a record of the phone calls they receive, receive new review lab results and X-ray reports and enable them to review them, and enable them to sign off electronically on medical order that need their approval, Schaaf says. Eventually, the system will enable Group Health’s doctors to send messages to physicians who work elsewhere.

“The functionality that we’ve had in the past gets more powerful by having one inbox and one view,” Schaaf says.

Group Health doctors and patients have been able to e-mail one another securely in the past with the HMO’s current MyGroupHealth system, and Schaaf says, “We’ve had secure messages from every continent, including Antarctica.”

Patients have had access to their medical records through MyGroupHealth, but with the new system will be able to set up their personal health pages to receive the results of their latest test and reformat those results in line graphs, bar graphs, or charts. That information together with their medical histories and after- visit summaries on their personal health pages will enable them to review exam results at home “in context,” says Pam Lake, associate administrator for clinical operations at Group Health’s North Idaho and Eastern Washington clinics. Already, the HMO’s MyGroupHealth Web site has enjoyed strong usage by patients, with 92,000 users, says Ray Summers, Group Health’s spokesman here.

With the new system, parents or guardians of children through age 12 will have secure messaging with their children’s doctors, plus access to the child’s immunization history, current health conditions, allergy information, and after-visit summaries.

The new system also will make doctors’ lives easier, Schaaf says. When he went back to using the old system after training on EpicCare, “My first day of seeing patients with the old system was excruciating, ” Schaaf says. “It Was like, ‘Rats, where’s this form? I have to order something. Where’s that form?’”

Group Health’s doctors here are “chomping at the bit” to begin using the new system, although some aren’t excited about typing in orders on the computer keyboard, Schaaf says.

Yet, the system should provide a “definite, obvious improvement in patient care,” Schaaf says, adding, “We’ve had docs who were contemplating retirement who’ve changed their minds.”

Karen Ziegler, Group Health’s assistant administrator for clinical operations, says Group Health has offered positions to some young doctors coming out of residency “who would not take the job unless we had an electronic medical record system.”

The system is costing Group Health, which has 20 West Side clinics as well as the five it operates in Spokane and Coeur d’Alene, $42 million systemwide, plus “a lot of intangible things, staff time, after-hours meetings,” Schaaf says.

Yet, it will produce benefits when doctors are away from the office, Lake says. She says that when doctors receive a call at home from a patient or about a patient, they will be able to use their computer at home to review the patient’s medical records, order a prescription or lab tests, or respond to a query from another doctor, including a practitioner from out of town or even from another country. Currently, “they have (only) what they had in their head,” Lake says.

Ziegler adds that with the new system, doctors also will be able to see the results of things that have happened, such as the results of a physical therapy session or a recent emergency-room visit, since they last saw a patient.

Schaaf, whose own father practiced medicine until he was 80 and who practiced with his father for a time, says that during his dad’s day, “All the data you needed to know, you could keep in your head. Now, there’s thousands of times more information than you can keep in your head. That data-management problem has come to interfere with the relationship with the patient. With EpicCare, we’ve started to come out of that.”

Group Health implemented the system last year in its West Side clinics, where, Schaaf says, “We’ve emptied out chart rooms in a lot of places.” The idea, he says, “is to become paperless.”

Copyright Northwest Business Press Inc. Sep 01, 2005