Medical records database promoted as a lifesaver
3/11/2001
Dr. Kenneth Bertka and office manager Pam Carter say accessing medical records can be facilitated by placing the information on a database, a move promoted by an area health alliance. THE BLADE/JEREMY WADSWORTH Dr. Duane Gainesburg, left, wants medical records placed on a database, using a plan by David Chatfield, right, president of Community Health Alliance of Northwest Ohio.
Dr. Duane Gainsburg believes patients and doctors should be able to review medical information in seconds by accessing them with the same ease as using a bank ATM card.
What conditions will insurance cover? Does necessary medication interact dangerously with something else being taken? Are immunizations up to date?
Those answers can be determined now, but it often takes a lot of paper shuffling and wasted time, said Dr. Gainsburg, a Toledo neurosurgeon who is promoting a computer system to centralize patients' medical information.
"I want to know what the patient's labs and X-ray data is, what medication they're on, and what other consultants have said about her. In order to find out now, it takes a huge amount of legwork and it's a substantial delay," he said.
In an effort to solve the problem, he helped form a non-profit group called the Community Health Alliance of Northwest Ohio that would set up a central patient medical records database. Patients would carry a credit card-like "MedCard" that would contain basic medical data along with demographic information such as name, age, and address.
Dr. Gainsburg is chairman of the 11-member, unpaid board of directors for the Alliance. He sees the database as a community benefit that any doctor or health system could use. However, establishing the plan has a way to go before the local medical community is convinced to try the new idea.
Representatives for area health organizations said the idea sounds appealing, but they want more information.
The database, which the Alliance wants to start by July, would serve patients in Lucas, Wood, and Fulton counties. Patients would have a choice whether to use the system, which initially would store only outpatient medical records.
Dr. Gainsburg insists the idea could have a dramatic impact on the health of the community. Reminders to patients and doctors about immunizations could be sent out automatically, disease frequency rates could be determined, effectiveness of certain treatments could be verified, and doctors could see how they're performing compared with their colleagues.
Here are some key components of the Alliance proposal:
David Chatfield, president of the Alliance and a freelance business consultant in Bowling Green, said the proposal could save money. Health systems and doctors could reduce the amount of paperwork and staff to manage that paperwork by using the system, he said.
Dr. Jim McGauley of Ann Arbor developed the technology that would power the effort. Dr. McGauley founded the MedCard company about five years ago and is president of the 10-employee organization.
His company has tested the technology in a Detroit suburb. The Toledo area would be the first location in the country to put the system into widespread use.
MedCard would benefit financially from the Alliance because it would receive access fees paid for by doctors or others who use the system. An overall cost estimate, including subscription fees, hasn't been worked out, Mr. Chatfield said.
There would be no cost to patients to use a MedCard or the database. Patients would be contacted by the Alliance through their doctors' offices to see if they want to participate.
Mr. Chatfield said patients might find the Alliance appealing for several reasons, including: reducing medication errors, because the system would automatically flag problems; decreasing the hassle of repeating information at each doctor's office, and cutting down on rejected insurance bills.
The Institute of Medicine, a policy and research organization that advises the federal government, released a report March 1 that echoes some of the concerns raised by Dr. Gainsburg and others about medical records. The report found that the U.S. health care system is woefully out of date and inefficient in storing and using patient medical information.
The Alliance proposal appeals to Dr. Kenneth Bertka, a family physician in West Toledo who has been briefed about the project.
"We spend a lot of time now trying to find old records and not duplicating tests. I've seen people have bad experiences; things like having a CAT scan repeated," he said.
Alliance board member Chuck Gallagher, who oversees health insurance for about 1,200 people as vice president of personnel for The Andersons, believes the idea has potential.
"One thing that's amazed me is that in this day and age, the administrative process and paperwork is so heavily manually driven I can't believe it. ... Probably the biggest complaint I get from employees is paperwork getting mixed up," Mr. Gallagher said.
One challenge for the Alliance is getting enough doctors and health systems in the area to participate.
Scott Fry, president of the Hospital Council of Northwest Ohio, said hospitals support the idea but it's too soon to tell if they will embrace the proposal. The Council is a lobbying, trade and educational group for hospitals in northwest Ohio.
Another challenge will be connecting everyone to the system. Dr. Bertka said "most hospital systems in town are not integrated enough themselves, let alone trying to integrate outside their system."
Similar experiments are being done in other areas of the country, but most are in "closed" systems where one health insurance or hospital system uses it solely for its patients.
"Here in the United States, because it's not a closed system, people change doctors everyday, change health plans everyday, and there is a lot of population turnover. In that environment, it's a real management nightmare," said Harry Rhodes, a director of the American Health Information Management Association of Chicago, which represents about 40,000 health information professionals.
Keeping the information in the system updated is another concern, Mr. Rhodes said.
"Let's say you're on the road and you're visiting your aunt two states away and see a doctor there. Is this database going to chase down those records, too?" he asked.
Finally, there's the issue of privacy. The idea of putting thousands of medical records on an electronic database could make people nervous about potential abuses of the data.
Twila Brase is president of the Citizens' Council on Health Care in St. Paul, a nonprofit advocacy group interested in patient privacy concerns, medical ethics, and health care redesign.
"The privacy concerns for this are enormous," Ms. Brase said. "The potential for divesting people of their privacy rights is big because the data is now there. It's easy for a legislature to say, for the public's own good, we need to allow access to X, Y, and Z."
Dr. Gainsburg said Alliance officials are well aware how careful they would have to be regarding privacy and said the group would work hard to ensure privacy. Dr. McGauley said there are "more than 20 levels" of security in the system.
Dr. Gainsburg admits it will be a challenge to convince enough doctors to use the system.
"If there are 1,200 [doctors] in the area and 800 use it, it's really not very useful because big holes occur by going someplace else," he said. "But we think that will be self-healing because the advantages will be so self-evident."
He said that once 150,000 patients are enrolled, Alliance hopes to go live and the interest generated will encourage other doctors to take part. Dr. Gainsburg said some doctors or hospital systems might be reluctant to embrace the Alliance model because it would make it easier for patients to be seen by rivals.
One fan of the database concept is Dr. Ralph Margulis, chairman of United Beaumont Physicians, a 1,300 physician group in the Detroit area that tested the system.
"It gives the answers to practically everything. We had a very favorable experience with it," he said.
Unfortunately, the Beaumont physician group stopped using the system about a year and a half ago. Dr. Margulis said it ran out of money to continue funding the system, which cost the group about $400,000.
At that time, the system relied on money from the physician group and costs to keep the system going at that time were too high, he said. H is group, however, would like to try it again, depending on the feasibility, he said.