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Hospitals slow to adopt e-records
(Pittsburgh Post-Gazette (KRT) Via Thomson Dialog NewsEdge) Mar. 23--It's a common complaint from the Jason Altmires and Newt Gingriches of the world -- you can use your credit card at an ATM in Rome, you can trade shares on the New York Stock Exchange from your iPhone. But your local hospital can't retrieve medical records from the physician's office or the pharmacy down the street.
Hospitals and general practitioners have been using computers for decades, since the late 1960s and early 1970s. Since the 1980s, when computer quality and speed began to improve dramatically, a computerized, paperless, top-to-bottom system has been the Holy Grail of American health care. In the 1990s, the evolution of the Internet was heralded as the transmission linchpin that would tie the system together, improving access to service, reducing medical errors and, in the end result, saving lives.
Yet American hospitals and doctors have been slow to wholly adopt digital record-keeping and transmitting technology. They spend billions of dollars on the latest MRI machines and CT scanners, and plenty more on billing, scheduling, payroll and so on. Hospitals, obviously, are generally teeming with computers.
Why, then, at the point of patient intake, are you asked by a receptionist, then a nurse, then a doctor, whether you're on any medication or have any allergies?
Why does your primary care physician still thumb through a manila folder, inspecting somebody else's handwriting, when he's trying to remember how your respiratory infection was treated the last time you visited? Why do hospital physicians still scribble a prescription on a notepad, then send it via courier or vacuum tube to the pharmacy downstairs, when it would be so much faster to do it wirelessly?
"Rome wasn't built in a day," said Dr. G. Daniel Martich, the chief medical information officer for the University of Pittsburgh Medical Center, which is recognized among peers as a leader in the adoption of health care IT. "It's amazingly time-consuming and a lot of it can be incredibly expensive. And unfortunately there are many points where you can miss."
UPMC alone uses 120 computer programs -- "clinical applications" -- from almost as many software and hardware vendors. Different systems use different vocabularies when they're talking about the same drugs, making translation software a necessity. The vendors themselves, usually for-profit companies, want to sell their own wares, and can be reticent to play ball with another company, Dr. Martich said. That forces hospitals, UPMC included, to design their own tools.
Imagine layering on top of that mess a master system that can conjure up a patient's entire medical history -- allergies, current medications, digitized MRI images, everything -- at the touch of the button, a file that can be safely passed between or accessed by a hospital, a primary care physician, a pharmacist and any other specialist you might use.
"The politicos, quite frankly, haven't walked in our shoes," Dr. Martich concluded.
Politicians, as they often do, make it sound so easy -- if only hospitals and doctors could get their acts together, by now we'd have an electronic system in place that would make paper records and note-pad prescriptions obsolete. In the presidential campaign this year, Sens. Hillary Clinton, Barack Obama and John McCain have all mentioned electronic medical records as an avenue for improved care and, more importantly, lowered cost.
But the reality is, despite decades of promises from Presidents Bill Clinton and George W. Bush, there has been little federal guidance on the issue. The health-care industry was encouraged when President Bush appointed Dr. David Brailer to be the country's first "czar" of health information technology in April 2004, but two years later, Dr. Brailer resigned from the position.
"Everybody was excited about" Dr. Brailer's appointment, said U.S. Rep. Jason Altmire, D-McCandless, a former UPMC lobbyist. "'Hey, we're going to take a big look at this.' And it sort of fizzled out." Leaders are still wrestling with how much direct funding to provide, and whether they should use the carrot or the stick -- reward health-care systems that meet certain benchmarks, or punish those that don't.
Either way, money is at the root of it. "If you're UPMC with $650 million in profits, you can afford to make it work," Mr. Altmire said. "If you're a rural hospital, they don't have the resources to make this work."
Washington, D.C., isn't the entirety of the problem, though. Where the financial and banking sectors were driving 10 percent of revenues into information technology, health care has been reinvesting about 3 percent, according to AT&T. Recent polling suggests a continuing embrace of technology -- half of all doctors now incorporate a hand-held computer into their daily routine, and more and more hospitals have installed wireless Internet and communications systems -- but that embrace isn't full enough for those who had hoped that e-records, as well as e-prescribing, would be here by now. Nine in 10 U.S. doctors and two-thirds of hospitals still use paper for most patient records.
This, after President Clinton proclaimed in 1994 that within 10 years, digital records would be the standard in health care.
"Who is going to pay for this? How do you get people to move?" asked David Merritt, project director for former House Speaker Newt Gingrich's Center for Health Transformation. "It's far more complicated than anything we've tried to do" -- not just in medicine, but historically, he said, superseding in enormity the interstate highway system, our millions of miles of telephone lines and the global financial network.
There are 6,000 hospitals, 800,000 physicians, 2,000 health insurers, 50,000 pharmacies in this country. "You try and connect all of those with 300 million citizens. It's a very daunting prospect."
Other developed countries are further ahead, both by virtue of their smaller size and the obvious fact that their health systems are nationalized, making it easier to institute and enforce national standards.
Federal grant programs exist, offering financial help to hospitals and small practices, but they nibble at the edges and don't help many doctors. And without money, most individual practitioners have little incentive to spend $50,000 or more
Some hospitals and doctors are waiting it out just to be safe -- why spend thousands or millions now if the federal government is going to step in at some point with its own system? In such a scenario, "all of the providers who did the right thing [now] are going to get caught," said Mr. Altmire, who is sponsoring a House bill that would mandate e-prescribing by a 2011 deadline.
Ironically, while Capitol and White House leadership has largely been lacking, another branch of the federal government has been a pioneer in e-records. When Hurricane Katrina wiped out entire hospital systems and doctors' practices in New Orleans, thousands of patients' health records were lost. But not veterans -- the VA's digital system meant that a vet could visit a VA hospital in another city and get treatment.
But the VA system's much-praised transition to computerized records also demonstrates the pratfalls of reliance on such a system. Computers containing patient information were lost or stolen, concerning privacy advocates. Last year, the House Committee on Veterans' Affairs learned about a system failure that knocked out important applications at 17 VA hospitals for a full day. And the VA has found that all the IT investment in the world doesn't matter if your system doesn't easily communicate with computers at the Department of Defense. Which it doesn't.
David Roberts, vice president of government affairs with the Healthcare Information and Management Systems Society, has been a health care IT advocate for more than two decades, but he understands why some people will always be wary of a fully computerized system. A few weeks ago, in fact, he visited his orthodontist and found that the office's computer systems had been down for two days.
Without paper records, "they had no idea why I was there or whether I had an appointment," Mr. Roberts said.
But the potential rewards far outweigh the risks.
"The issue is now front and center," he said, citing polling that consistently identifies health care as one of the most important domestic issues. "The trick is trying to find out the best way to fix those issues."
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Copyright (c) 2008, Pittsburgh Post-Gazette
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