Move to electronic health records to speed up
This goes way beyond e-mail’
Are you part of a health care organization that is up to its collective ears in paper-based patient clinical records? Are you drowning in papers prepared for payers? Are you floundering in folders that hold everything — except exactly what you’re looking for?
If so, you have plenty of company. The fact is that a vast number of health care facilities are still waiting to reap the full benefits of the computer revolution.
Defined at its simplest: "The electronic health record (EHR) is a computer-stored collection of health information about one person linked by a person identifier," explains C. Peter Waegemann. He is executive director of the Newton, MA-based Medical Records Institute, an organization dedicated to promoting the evolution, development, and acceptance of electronic health record systems, and chairman of the health care informatics board of the American National Standards Institute.
There are several evolutionary levels of EHRs to be found in today’s health care delivery systems, says Waegemann. Most modern health care organizations currently operate at the lowest level, utilizing what is called an "automated medical record," he notes. "At this stage, there is a substantial amount of patient information stored on computer, [but at the end of the day], there is still an ultimate reliance on the paper-based record."
The second level is known as the computerized medical record, according to Waegemann. At this level, not yet fully achieved anywhere, he notes, optical scanning technology is utilized to capture data from paper-based systems, eliminating the need for paper records.
The next rung up the evolutionary ladder is the electronic medical record, which is envisioned as allowing "access to computerized patient information within a single health care enterprise — one hospital, one clinic," says Waegemann. The fourth level, the electronic patient record (EPR), is a true patient-focused virtual record, with the scope of availability expanded from single to multiple enterprises, "from the dentist to the doctor to the psychiatrist to the school nurse."
On the top rung of the ladder is the virtual Holy Grail of the EHR movement. The "true" EHR is an electronic compendium of all information pertinent to an individual’s health and well-being, according to Waegemann. "It differs from the EPR in that it is not limited to information captured by caregivers regarding a patient, but includes interaction with the patient in all aspects of data entry. Additionally, it includes wellness information and other health-related information that is not part of the traditional care delivery process," he says.
"The computerized patient record is certainly a factor in making real-time patient care easier, but being able to come up with measures of quality is equally important," says Sheryl L. Taylor, RN, manager of the Healthcare Emerging Technologies Group at Ernst & Young’s Washington, DC, office. "But, what a lot of VPs of nursing and provider CIOs will tell you today is that they need these record systems to be able to get the outcomes data to prove to payers that they are not only cost- effective but that they also deliver quality."
In the eyes of some, the computerization of patient records, ultimately leading to the establishment of the EHR as the industry standard, has potential impacts that go well beyond efficiency of care and gaining marketing advantage.
"Visionaries in both delivery and provider organizations in the health care industry have identified the computer-based patient record, or at least on-line access to individual patient clinical information, as a necessary component in creating a new bond between doctors and patients, allowing them to interact on an ongoing basis," says John Quinn, principal in charge of the Healthcare Emerging Technologies Group for Ernst & Young LLP in Cleveland.
In this view, the Internet becomes the place where patients can both communicate with their doctors and access their own medical information.
"This goes way beyond e-mail," says Quinn. "I’m talking about things like having patients schedule appointments, enter their histories, access the immunization records of their children, and get information from their doctor pertinent to their health situation." Individual patient information accessible via the Internet could include items such as the results of recent blood tests with cholesterol numbers, as well as other types of data aimed at promoting wellness, as opposed to treating chronic conditions, he adds.
Get serious and ask questions
And when most health care enterprises get serious about this subject, they team up with one or more of the legion of vendors in the field. Ask that segment a lot of questions, says Quinn.
"Look for a vendor that has actually successfully put in a computer-based patient record system, and find out where and how broadly it was implemented on-site," he advises. Most vendors can easily provide a list of places where they have implemented systems. "But when you dig deeper, you find out it was in a single department or specialty area. In other words, it was more like an experiment, as opposed to being an enterprisewide solution."
And just as important, "ask about the resources, in terms of time and money, it truly took to put the system in place," adds Quinn. In general, the answer to that question has been fairly disappointing when it comes from health care organizations that are taking steps toward the EHR, he notes. "We’ve seen a lot of people go in with a lot of enthusiasm but wind up getting bogged down in implementation."
In many instances, "They get a system up and running in one part of their organization, and then they stop, largely because they are out of breath and start to realize that they seriously misjudged the amount of time and money it takes to accomplish what they are trying to do."
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