Monday, July 23, 2012

Digital records empower many medical patients

Just before Dr. Terry Fuqua closed his internal medicine practice in 2008, he ran ads in the New Era that encouraged patients to come pick up their medical records.
Only about a third of his patients took the offer. So Fuqua destroyed the records from patients who hadn’t visited in more than five years, and he brought the remaining 50 to 75 cases home and stored them in his garage.
He continues shredding records that pass the five-year mark.
He still has word processor documents with detailed notes from patient visits. But since his retirement, he estimates that fewer than a dozen former patients have called him for records.
Fuqua retired on the cusp of a new era. Technological developments are sweeping situations like this into the past. One day nearly all patient records, including those at hospitals and doctors’ offices throughout this area, will survive the way Fuqua’s notes have: on computer hard drives or in cyberspace.

It’s impossible to nail down a timeline for Christian County, but the federal government is pushing providers to convert by 2015.
Experts debate about whether the conversion will ultimately save doctors time and money. Some also fear medical information will leak electronically, and they worry doctors won’t take thorough notes or talk freely with their patients when they’re typing on laptops.
But in terms of accessibility, the shift to digital records will almost certainly empower patients.
Medical communities
In three cities in far Western Kentucky, each medical community has approached the paper-to-digital conversion differently.
In Madisonville, most of the doctors who work with the major medical company, Trover Health System, are full employees of Trover. Instead of running independent offices, they work in buildings Trover owns and draw their paychecks from the company.
So when Trover switched to digital records about three years ago, it equipped and trained most of the city’s physicians. Primary care doctors, specialists, nurses, lab workers and radiologists could share notes, medical histories, X-rays and many other materials instantaneously, said Tammy Ripa, Trover’s director of business services.
Owensboro Medical Health System works with a mix of doctors: some on its staff, some who run independent offices.
OMHS invested roughly $50 million to go fully digital, said Shanda Coomes Bland, administrative director of the company’s OneChart program.
But it doesn’t restrict its system to the hospital campus. It encourages doctor’s offices to participate in the network, and for those who invest in the proper technology, OMHS goes a step further: It sends a technology team in to implement software, train doctors and staff, and stay around in exam rooms for several days to make sure everyone can use the system comfortably. Thereafter doctors rely on OMHS for technical support.
As of last week, 23 doctor’s offices in Daviess County were connected to the system. Two more will connect this summer, Bland said.
Jennie Stuart Medical Center finished its conversion about three and a half years ago, which put it slightly ahead of the medical industry’s curve, said Jerry Houston, Jennie Stuart’s director of information technology. Now each patient has a single digital file that all departments in the hospital share.
But the majority of Christian County’s doctors are self-employed, though most have access to Jennie Stuart’s facilities. This makes it hard to determine the state of paper-to-digital conversion throughout Christian County.
Doctors don’t report to any central agency regarding plans to go digital.
Epic Systems, the technology vendor OMHS uses, encourages its clients all over the U.S. to help implement software in smaller offices, said Carol Slone, of the consulting agency Impact Advisors. But Houston said Epic is expensive, and it has traditionally worked with larger hospitals than Jennie Stuart.
At least a few organizations outside Jennie Stuart have taken strides toward digital conversion.
The Pennyroyal Mental Health Center shares digital records between its new primary care center and its psychiatrists and other mental health professionals. Lisa Bridges, a nurse at the primary care center, said this helps with the staff’s efforts to integrate physical and mental treatment. For instance, if a patient is having mental side effects from a drug, the psychiatrist can view the patient’s prescriptions and work with the doctor who assigned the problematic drug.
Doctors from Bluegrass MD work in the Pennyroyal Center’s primary care unit, and Bridges said those doctors use digital records extensively in their own practice.
The Kentucky Department of Public Health supports a software system that the Christian County Health Department uses. The software doesn’t communicate with most other record systems, said CCHD Director Mark Pyle. And the federal government hasn’t given local health departments money for upgrades.
Pyle said he wants to implement electronic records as soon as these barriers go down.
Sharing statewide
Efforts like these are producing a statewide exchange of medical information. So if a Madisonville resident gets in a car crash in Lexington, nurses there have instant access to her file.
While she lies unconscious, they can learn about her medical history by keying in the name on her driver’s license. They can view her X-rays, see what medications she’s on, and if necessary, call her doctor.
This framework, called the Kentucky Health Information Exchange, operates under the Cabinet of Health and Family Services. Federal money funds its operation.
It has more than 100 participants.
Jennie Stuart has signed an agreement with the governor’s office to participate, Houston said. Hospital employees are now making sure the Jennie Stuart information system meets the state’s technical requirements. Jennie Stuart plans to go live with the exchange in September.
Because of funding and privacy issues, state-level exchanges like this one aren’t yet sharing information with each other on any major scale. Ripa said Trover staff still contact hospitals directly for records from Tennessee or Indiana, for instance. But perhaps in 10 or 20 years, nurses in Oregon will have instant access to patients’ records in Florida and Maine.
Patient benefits
In some ways, electronicrecords make communication safer for patients — especially with prescriptions.
“Physicians are notorious for poor handwriting,” Houston said.
If a pharmacist misread a number or the placement of a decimal, it could result in a medical emergency, Houston said.
Harry Weathers, who works at Cayce’s Pharmacy, said he doesn’t know of poor handwriting causing any serious problems for clients. But the pharmacy calls doctors’ offices all the time for clarifications, he said. Now that a third or more of prescriptions at Cayce’s come electronically, those calls are decreasing.
When doctors work from the same medical chart, they’re also less likely to order redundant X-rays or CAT scans. They can sort data quickly instead of flipping through pages.
Trover used to take 30 days to provide patients with copies of their records, Ripa said. Now it provides copies on CDs or flash drives within just three days, and on the same day when necessary. Jennie Stuart has brought its wait time down to five to seven days for most orders, said spokesman Jim Goss.
Looking forward
The federal government’s timeline for incentives and penalties might give some clue to as to when local residents can expect all their records to be digitized.
Providers that meet certain “meaningful use” requirements with their records systems can get a reimbursement as large as $63,750.The requirements include transmitting prescriptions electronically and maintaining electronic medication lists for patients.
Starting in 2015, providers that don’t use electronic systems will get a 1 percent decrease each year in their Medicare payments. This could continue until they reach 5 percent.
Bland said doctors planning to retire soon may just accept the penalty. But after they overcome the learning curve, those who adapt seem to like it, she said.
“We’re really now building this community health record,” she said. “It’s so exciting to see new providers coming on to the system to realize this — that, ‘Wow, it really is all about the patient.”

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