Doctors prescribe electronic records
- BY FELICE J. FREYER Journal Medical Writer
By linking every medical office in the state, physicians hope to improve the quality and safety of health care.
Tuesday, April 11, 2006
Imagine you're in your doctor's examining room. Your doctor walks in, but she doesn't have the familiar manila folder with your medical records. Instead, she's toting a laptop.
As you describe your symptoms, she enters the information into the computer, which provides her with test results, reports from your visits to specialists, and prompts suggesting appropriate care.
After she examines you -- no computer can do that -- she writes a prescription, by entering it into that same laptop. The computer tells her which drugs your insurer covers, and alerts her if you're on other medications that might conflict. In seconds the prescription arrives at your pharmacist.
That is the vision that was put forth yesterday under the State House rotunda, as a doctor-led company called Electronic Health Records of Rhode Island, or EHRRI, announced a plan to try to wire all medical offices in the state.
"Our mission is to dramatically improve the quality and safety of health care," said Dr. Mark D. Jacobs, chairman of EHRRI's board of directors and president and chief executive officer of Coastal Medical.
The unusual partnership -- bringing together physicians from five disparate organizations -- represents nearly half the doctors in the state. EHRRI has chosen a software vendor, eClinicalWorks of Westboro, Mass., which is providing the system at a discount to doctors in the group. Then, EHRRI intends to sell the same system to other doctors, hoping that donations from insurers and other affected groups will enable them to offer more discounts.
EHRRI's work could make a difference because, chances are, your doctor is not eager to have that laptop in her examining room. The process of switching to electronic records is hugely complex, time-consuming, and expensive -- and brings no immediate benefit to the doctor. Many doctors in Rhode Island work in groups of three or less, making such changes especially daunting. Only a small minority are thought to have already adopted electronic records.
But doctors also know that insurers and government regulators are going to demand information, and quality control, that only a computerized office can provide. The state already has a $5-million federal grant to plan the systems by which doctors' offices, laboratories, pharmacies and hospitals can communicate electronically. But the doctors have to get their own equipment to plug in.
Jacobs said that EHRRI will do much of the advance legwork for other doctors. The group, incorporated in October, had already vetted numerous systems before settling on eClinicalWorks. Now it will test-drive the system -- Jacobs' own office, in Johnston, will be one of the first to go online this summer -- before offering it to other practices, along with help with installing, maintaining and troubleshooting.
"We'll have designed the blueprint," Jacobs said. "Others can follow. Others won't make the same mistakes."
U.S. Rep. Patrick J. Kennedy, who has led a national effort to promote electronic health records, applauded the move, which he said would reduce errors and duplication, and make it easier to measure quality.
But Kennedy also raised concerns about the privacy of electronic medical records, saying better legislation was needed to put patients in control of their records and who sees them.
Girish Kumar, president and founder of eClinicalWorks, said electronic records can be more secure because they limit who can access them and keep track of who does.
EHRRI was spawned by the Rhode Island Quality Institute, a nonprofit group that two years ago set up a committee of physician leaders to recommend the best systems for electronic health records. As those people talked, they came up with the idea of choosing a single vendor, and winning discounts from the vendor by marketing the system to a large group of doctors.
The physician-services organizations at the Lifespan hospital group, Women & Infants Hospital and Kent Hospital, together representing 1,200 doctors, joined forces with Thundermist Health Associates, a community health center with two facilities, and Coastal Medical, a primary-care group practice with about 70 doctors. They formed EHRRI, a for-profit company.
Blue Cross & Blue Shield of Rhode Island contributed $300,000 to the effort. Yesterday, James Purcell, Blue Cross president, said the insurer intended to pitch in more, and EHRRI will approach others.
Newell Warde, executive director of the Rhode Island Medical Society, acknowledged that many doctors regard "getting wired" as a pointless and costly burden. "It's not just the initial investment," Warde said. "It changes the way your office works, the way your work flows."
In the end, though, physicians will probably benefit, Warde predicted. The federal government and insurers are moving toward paying doctors more when they meet standards of care; those who can show, through electronic records, that they've done a good job stand to benefit financially.
Dr. Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology, a national group that will enforce standards for electronic health records, said that the Rhode Island effort is unusual because it is led by physicians.
"The number-one obstacle is the cost," Leavitt said, noting that in a small group, it costs $40,000 to $50,000 per physician to adopt electronic records.
Leavitt says he favors any effort to promote electronic medical records. "There's tremendous benefit to the patient," he said. "When the physician knows all the information, they're going to make better decisions for the patient."
For example, Leavitt said, some 11 percent of all lab tests were redone because the results couldn't be found in the medical chart. Computers will do a better job of keeping track, he said.
But the benefits depend on the quality of the systems doctors adopt, cautioned Dr. Scot M. Silverstein, director of the Institute for Healthcare Informatics at Drexel University in Philadelphia.
Poorly designed systems can actually lead to more errors and greater inefficiencies, Silverstein said. For example, an article in the September Journal of the American Medical Association detailed how a major hospital's computerized system for physicians to order drugs actually contributed to 22 types of medications errors.
"Health care is not 'plug and play,' " Silverstein said. "It's very complex."
ffreyer@projo.com / (401) 277-7397
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