Archive for Sunday, June 9, 2013

Have electronic medical records worked as advertised?

Cory Roelofs, a case manager for the Lawrence-Douglas County Health Department, helps Roberta Woodman stay in her Lawrence apartment through the Project LIVELY program. Roelofs helps many elderly residents with their health problems, using a new digital database to more easily store and search their records.

Cory Roelofs, a case manager for the Lawrence-Douglas County Health Department, helps Roberta Woodman stay in her Lawrence apartment through the Project LIVELY program. Roelofs helps many elderly residents with their health problems, using a new digital database to more easily store and search their records.

June 9, 2013


Dr. Philip Stevens looks his patients in the eye when he talks to them. After each appointment, he dictates his notes on the visit to one of his assistants, who writes it down in long hand. His office in Tonganoxie doesn't have a computer or fax machine. He has meticulous paper records dating back 57 years.

But even Stevens, 85, acknowledges he's the last of a breed that will soon be extinct: physicians who don't use electronic medical records.

While there is no mandate, doctors who don't go digital by 2015 will receive reduced Medicare and Medicaid reimbursements. Providers who implement electronic systems, meanwhile, get financial incentives from the government.

The American Reinvestment and Recovery Act of 2009 provided $19 billion in funding to implement electronic medical records nationwide. Providers who made "meaningful use" of such systems earned bulked-up Medicare and Medicaid payments, about $44,000 per doctor. Much of that money went toward helping the physicians install the new programs, which generally cost anywhere from $15,000 to $70,000, on top of a monthly maintenance fee.

Nowadays doctors like Stevens are in the minority. About half of doctors' offices and 80 percent of hospitals will have electronic health records by the end of the year, up from 17 percent and 10 percent, respectively, in 2008. And many in the medical community believe it won't be long before most physicians are part of a nationwide network in which they can exchange patients' records electronically — the goal in Kansas is to have 80 percent of providers sharing information digitally by 2016.

But five years after this push began, are digital medical records providing better, less expensive care?

LMH a digital leader

Lawrence Memorial Hospital was an early adopter of electronic records, moving toward a digital system in the early 2000s. The hospital has been recognized as one of the most wired in the country.

CEO Gene Meyer said it will take more time for many of the advantages to be fully realized, but he noted that the new system has allowed physicians to exchange information with greater ease, made records more legible and reduced the duplication of tests. "From a communication and a patient safety and an efficiency standpoint, it's provided a lot of benefits," Meyer said. "But it's been a huge change for the way we do business. It's been a learning curve for physicians."

Lawrence's Heartland Community Health Center plans to use its electronic record system, installed last year, as a centralized database for all of its patients' care, storing appointment records and test results — whether they took place at Heartland or not — as well as hospital reports all in one place.

The Lawrence-Douglas County Health Department, meanwhile, went digital in January. Experts say it takes about 12-18 months to fully implement the systems.

Kim Ens, director of clinical services at the health department, said she expects the switch to help the agency spot health trends in the community and evaluate the efficacy of various programs.

The system cost the department about $66,000, plus a monthly fee of $2,300. Eventually, it is expected to increase the number of appointments the department can facilitate and its amount of billable hours, leading to an estimated savings of $30,000 per year, according to Jennie Henault, director of administrative services.

The department's Project LIVELY program, which helps keep elderly residents in their homes, has already seen results from the new program. Case manager Corey Roelofs used to take notes during visits and then transfer them into the system when he got back to the office. Now, he enters them into an online database he accesses from his laptop while meeting with patients. He also doesn't have to ask identifying information — date of birth, Social Security number — every time like he used to. "It helped us become more efficient, and I feel we can provide better service," he said. "I guess the only down side is now I'm totally dependent on it, and if I forget my computer or lost it, I'd have to go back to a notepad."

On Roberta Woodman's couch at Vermont Towers on a recent afternoon, her pug snorting and watching from the floor, the 72-year-old showed Roelofs a letter saying she had been denied health care benefits. He hit a few keys on his computer and, almost instantly figured out it was a mistake, pulling up the number of the person who could help alleviate the situation. "I have all that information right at my fingertips," he said.


While there are still many technology-averse doctors like the 85-year-old Stevens, Lawrence primary-care physician Ryan Neuhofel, 32, is on the opposite end of that spectrum. He conducts appointments through Skype and FaceTime, communicates with clients through email and Twitter, and has patients sign receipts on an iPad. He doesn't have a single paper record in his office.

It's his opinion that the switch to digital is happening at a pace familiar to the health care field: glacial. He also thinks the initial push for electronic medical records was to make billing and coding easier, mostly benefiting insurance companies.

"If you read a medical chart produced electronically, it's like hieroglyphics. It's a mishmash of codes and outputs," Neuhofel said. "For the simplest encounter — like a follow-up on high blood pressure — the notes are four pages long. If I was talking to a doctor in person, he could say what happened in about 20 seconds."

Because the new programs are so complex, Neuhofel said, doctors often have to have as many administrative employees as before just to manage them.

"A lot of the systems are very hard to use," he said. "I design websites and software programs and I've found myself being very frustrated with how poorly designed they are. When you're used to using very clean designs — a MacBook, an iPhone, Twitter, Facebook — and you sit down on an EMR (electronic medical record system), it's like stepping back in time 15 or 20 years."

While Neuhofel uses a free, Cloud-based health record service, he also doesn't have any federal standards to meet — he doesn't take insurance of any kind, public or private. But even a skeptic like him believes technology will one day make medicine more efficient and patient-friendly — it's just going to take a while.

"Health care is such a convoluted system that nothing moves quickly. It's 10, 15, 20 years behind," he said. "It will eventually happen, just not in the next two or three years."


purplesage 5 years ago

Electronic charting increases time spent on paper work. toe is precisely on point: governmental takeover of the health care system is coming and quick access is what they need to pull it off.

Ron Holzwarth 5 years ago

"Electronic charting increases time spent on paper work."

I think you would change your opinion if you were to have a standard 20 to 30 minute appointment with a physician equipped with the VA system that knows how to use it.

You're in, everything is covered, your information is charted, and you're out in 20 to 30 minutes. The charting time is maybe 2 minutes at the very most, and usually less. That's how they process so many patients through so quickly.

Another time saving measure is that it takes less than 2 minutes to review your records. That time is included in the standard 20 to 30 minute appointment time. The only real limitation to how quickly it all works is the physician's reading and typing speed.

Leslie Swearingen 5 years ago

Well, I love it. When I had blood clots in both lungs the doctor suspected what was going on and when I got to the hospital emergency room they were waiting for me and had my records and knew what was going on. No wait, no explaining.

I go to Mt. Oread which is part of LMH and it is just so great that all the records are integrated from one place to the others.

I also like used the Patient Portal which allows me to send real time information to my doctor, make appointments, any time I need. I also have the complete records of my doctors appointment in writing so that my daughter can read them when she has time and thus keep up to date with how I am doing.

Carol Bowen 5 years ago

While Obamacare might be encouraging computerized records, they have been around for a while, even in Lawrence. Like Frankie, I have had a couple of occasions when it was really great to have my medical records readily available. When computerized medical records were first discussed, I had privacy issues. Still do, but then none of our personal information is private and hasn't been for a long time. The high schools sell mailing lists. Organizations like AARP let insurance companies know when you are a senior. Marketing calls out of nowhere. Let's not get started on Facebook and google.

Ron Holzwarth 5 years ago

The VA has been using computerized records for many years, and there have been no problems other than very brief outages. I go to the VA hospital in Topeka, and in 2000 or so I visited California and ran low on one of my medications. I talked to a nurse at the VA in Loma Linda, she pulled up my chart on the computer screen, and with no discussion at all about what my problem or diagnosis was, she informed me that my meds were going to be mailed and I should have them at my temporary California address in a few days. They showed up right on time.

All of the 153 VA hospitals in the USA are linked, so as you travel your medical records are readily available.

Another time I thought I broke a finger, and I had it X-rayed at the VA in Wichita. It turned out to be cartilage damage, and not a fracture. It was then that I learned something - film X-rays are so last century. They had an odd box, and I was to hold my hand above it. Then came the exposure, I don't know what it was, but I don't think it was an X-ray. Then, the data was mined from the box and it was cleared for the next patient.

And now, over 10 years later, a digital image of my X-ray is still available at any of the 153 VA hospitals with about 2 second's notice. When you look at it on the computer monitor, it looks exactly like a film X-ray.

Liberty275 5 years ago

So I take it you are good with computerized voting.

Michelle Reynolds 5 years ago

I know that every time I go to the doctor my and we review my history it's always wrong. They say they must have put in the wrong code. I even did bloodworm and the nurse filling out the order didn't know which of the 20 codes for Mono blood test was the right one. It took 3 people to figure it out. Guess what? They ordered the wrong blood tst. Had to do it again. I think a doctor worrying about his patience health is more important.

pti3 5 years ago

cynic: To call those who take seriously privacy of medical records 'paranoid' shows how little you understand the issue.
For an intro to some of the issues involved, see below: Medical Records and Privacy

And on the recent Supreme Court DNA case, see:

Leslie Swearingen 5 years ago

There is absolutely nothing in my medical records that I would consider "private" and be seriously worried if someone read them. My medical care has been impeccable and my doctor is always right up to date and correct about all of my medical problems.

I have never heard anyone say anything about codes, though I do know what they are.

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