Dr. Kelley Shultz, assistant director of inpatient pediatrics at Mercy Children's Hospital in Toledo, uses a mobile computer to keep track of patient records. The device increases access to patient information, both in and out of the hospital.
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Dr. Kelley Shultz demonstrates what happens if she places the wrong medication order for a patient.
On a computer screen in front of her, a warning message immediately flashes.
"It's helpful because then you say to yourself, 'Oh yeah, I didn't want to do that,' " said Dr. Shultz, a pediatrician at Mercy Children's Hospital in Toledo.
Doctors, hospitals, and recently President Bush have been worrying a lot about "that." Studies have found that as many as 100,000 Americans die every year because of medical mistakes.
Those statistics, fears of litigation, avoiding expensive duplicative tests, and improving patient care prompted Mercy Health Partners to establish an "electronic health record" at Mercy Children's Hospital. Mercy will spend $13.5 million by the end of next year to establish the system at its other hospitals: St. Vincent Mercy Medical Center, St. Charles Mercy Hospital, and St. Anne Mercy Hospital.
ProMedica Health System, the other dominant health provider in the area and owners of Toledo Hospital, Flower Hospital in Sylvania, and Bay Park Community Hospital in Oregon, has spent millions over the last decade developing its own version of electronic records.
Definitions vary, but an electronic health record generally allows a patient's medical information to be stored digitally instead of in a paper file. Computers remind doctors to order certain tests, warn them if they order the wrong drug, avoid duplication of expensive procedures, and - theoretically - allow a physician to track a patient's health history even if the patient is seen by other physicians in different states.
A portion of Mercy's electronic record system has been in place at St. Charles Mercy Hospital in Oregon since 2003. "We're seeing a dramatic decrease in potential errors, or errors avoided," said Steve Larrow, who oversees that part of the project for Mercy.
President Bush has made the implementation of electronic medical records by the nation's physicians and hospitals a priority. But federal officials, as well as Mercy and ProMedica officials, realize there's one significant hurdle to overcome: getting competing electronic systems to work with each other.
That obstacle might sound odd considering how easily other industries use similar technology. For example, you can use an ATM card to withdraw cash from anywhere in the world, even if your bank is in Toledo. But say you live in West Toledo, are allergic to penicillin, and get in a car accident in Oregon. When you're rushed to a hospital there, emergency room doctors will have no idea of your allergies or other vital information because it's likely sitting in a paper file in your physician's office a few miles away.
The problem of freely exchanging medical records electronically frustrates Dr. David Brailer, who President Bush put in charge of the federal Office of the National Coordinator of Health Information Technology.
"We consider this to be our primary concern," Dr. Brailer said. "Today, systems can't share data. This means there's fragmentation of the patient experience and [it] leads to extra treatment and errors will continue."
Dr. Ken Bertka, a West Toledo family physician and medical director of Mercy's clinical information services, said some of the Mercy system's functions include instant warnings to physicians and nurses when drugs are prescribed incorrectly, online lab results, and immediate access to patient treatment guidelines. The system eventually will allow a physician's notes to be included in the electronic file.
But Dr. Bertka agreed that a system like this is only half the solution. For example, Mercy's program only applies to its hospitals. It can't exchange information with a rival hospital a few miles away.
And then there's the doctor's office, where most patient care is delivered. Mercy's system allows physicians some access to inpatient electronic health records from their offices. But those records don't link with a patient's outpatient medical information either because the information is on paper - most of the nation's physicians use only paper records - or because a private physician's office computer system isn't compatible with the hospital system.
"What we need is that national piece," Dr. Bertka said. "Right now, records are not transportable."
Nevertheless, Dr. Bertka maintains that "it's all very doable. The model that fits most closely is the ATM model. Right now I can walk into a tiny little bank in New Mexico with three branches, but it can connect to a bigger system, and I can withdraw my funds from my bank in Toledo."
What's ultimately needed, health-care professionals say, is a set of universal standards for every electronic medical record no matter where it's stored or which technology is used to create it. These standards would dictate some basic information that could be easily accessed by physicians and hospitals. For example, patients' allergies to penicillin, their cholesterol levels, and the results of lab tests are some information that could be included.
Work is under way to develop a set of standards. A collaboration of trade groups that develop medical technology has formed the Certification Commission for Healthcare Information Technology.
Dr. Mark Leavitt, who chairs the commission and is medical director of the Healthcare Information Management Systems Society, said the commission hopes to have a pilot program ready by this summer.
"We're trying to come up with what's essential" to include in a shared medical record system, he said. These standards would have to be agreed to by everyone, he added.
"We're trying to prevent a VHS and Beta thing from happening in health care," Dr. Leavitt said, referring to the competing video-recorder technology of the late 1970s.
Thomas Della Flora, ProMedica's vice president of information services, said standards are needed, but what's really critical is one, single number to identify each patient that everyone agrees to use.
Known in industry lingo as a "national patient identifier," it would speed the development of a universal medical record because it would be easy to keep track of the right person.
After all, Mr. Della Flora said, there are a lot of Smiths and Johnsons in the world, and using Social Security numbers was deemed impractical.
But federal law currently prevents development of a universal patient number because of privacy concerns. In fact, concerns about who has access to medical information is a key issue that needs to be worked out, even if a single patient identifier number isn't developed, according to Dr. Leavitt.
Right now, about 15 percent of the nation's physicians and hospitals have electronic records in place, he said.
Dr. Brailer said the goal is that by 2014 "half of all doctors and hospitals in the United States need to have electronic health records in place and they need to be all hooked together."
Dr. Leavitt said it's a lofty goal but one that's achievable because "the interest in this has just exploded."
That interest is being driven by Medicare and insurance companies. Both eventually will demand that health-care providers have electronic health record systems in place and pay less to those who don't and more to those who do, Dr. Leavitt said. Despite not having one common number to use to identify patients, he said, there are other ways to accurately track patients by using complicated computer-matching programs.
Mr. Della Flora is skeptical, saying that ProMedica uses those matching programs and still has to manually examine about 400 patient records daily to make sure it's dealing with the right patient. Expand that process to the national level and it would quickly get confusing. Better to just develop one number to track patients, he said.
"If you don't have that," he said, "ultimately we'll fall short."
Contact Luke Shockman at: firstname.lastname@example.org or 419-724-6084.
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