Charting a New Course

Electronic Medical Records Are Here, and They Come Not Without Challenges, Controversy or Expense

(CBS)  For all the sound and fury about reforming health care, one very big change in the way our health system works is already quietly underway. Our Cover Story is reported now by David Pogue of The New York Times:

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"I understand how difficult this health care debate has been," president Obama told Congress on Wednesday. "I know that many in this country who are deeply skeptical that government is looking out for them."

The president's plan to redesign the nation's health care system turns out to be just the tiniest bit controversial - as footage from a recent protest ("Pure government take-over!") reveals.

But what you may not know is that Congress has already approved and funded one program: the plan to computerize your medical records.

"Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives," Mr. Obama said Wednesday.

Actor Dennis Quaid ("I'm not really a doctor. I don't even play one on TV!") is a believer that computerized health systems save lives.

In 2007, his newborn twins were victims of a terrible medical mistake.

"About a week after we brought them home from the hospital, they started to develop what turned out to be a staph infection," he said. "They were supposed to receive a 10-unit dose of heparin. And the nurse had the wrong bottle and gave them a 10,000 unit dose each of the drug. And they were in real danger of dying."

They were 12 days old. "Thank God they pulled through," he said.

But Dennis Quaid became a man with a mission. He began researching hospital errors, immersing himself in medical journals, even testifying before a Congressional committee.

"Up to 100,000 patients in the United States alone die in hospitals every year because of medical errors," he said before the House Committee on Oversight and Government Reform on May 14, 2008 (left). "That's the equivalent of one major airline crash a day, every single day of every year."

At the moment, your health history is probably kept on paper. That's how 90 percent of hospitals and 83 percent of doctors store them.

There are thousands of such folders in the office of Dr. Claudia Gruss, a gastroenterologist in Connecticut.

She calls the charts and patient demographics "kind of a snapshot of what the patient's medical history is."

Few other industries still rely on paper records. There's no backup, no way to search them all at once, no way to harness them en masse for research.

But that's going to change.

If you're wondering what the future world might look like where all medical records are electronic, you don't have to imagine it. Kaiser Permanente has just spent $4 billion and five years installing an electronic medical system in its 430 offices and 35 hospitals, including one we visited in Santa Clara, Calif.

Dr. Todd Dray is an ear/nose/throat surgeon at Kaiser Santa Clara hospital. He showed us an imaginary patient's computerized records.

These electronic charts contain everything the paper ones do, and much more.

"Medications, allergies, immunizations, any special comments by the providers," Dray explained. "And this is a look at all of the laboratory results and also the x-ray results."

"This guy's a mess!" Pogue said.

"This person is not healthy, yeah!" Dray laughed.

In a traditional hospital, if you want to look up patient details, you have to run to the records office and pull the chart. But in Kaiser's hospital here, there are 5,000 terminals, including these WOW carts (that stands for Wireless On Wheels).

(They tried calling them Computers On Wheels, but "cow carts" didn't go over.)

We saw a WOW cart in action when an unconscious patient was rushed into the emergency room.

"She is actively getting all vitals and all the different pieces of care that the patient's getting," Dray said.

"And in the old days, it would have been somebody with a clipboard?" Pogue asked. "And then what would happen to the clipboard?"

"Then the clipboard, let's say for instance the patient needs to go for an x-ray," Dray said. "We have to make a decision: Does the clipboard go with the patient during the x-ray? Or does it stay here in the emergency room so it can be studied? But, with this [electronic] record, the information can be instantaneously available in multiple places."

So what information technology could have prevented Dennis Quaid's ordeal? Barcodes.

"There is a barcode in every checkout stand in every supermarket in America," Quaid said before Congress. "Why can't there be one in hospitals?"

Janet Mendoza, a nurse at Kaiser, gave us a demo of barcode guns.

"And what if you're about to give me the wrong medicines?" Pogue asked.

"When we scan your name and we scan the patient's medication, the medication-administration record will pop out and say, 'Wrong medication.'"

"Really?"

"A big red stop sign that says, 'Wrong medication.'"

"Would you go so far as to say that this bar coding system at this hospital has actually saved a life?"

"It has saved errors, yes," Mendoza said.

So computerized record systems prevent errors; they save time; and they save lives.

Unfortunately, they're also unbelievably expensive and time-consuming to set up.

Dr. Jack Cochran oversaw Kaiser's switch to an electronic system, which is the country's largest non-government installation. It was by no means smooth sailing.

"The total term of deployment is between four and five years from start to finish," Cochran said. "And that's a massive deployment - over 100,000 employees including physicians. You have to buy computers and software and that sort of thing. But you also have to make a very determined investment in training."

"Did anyone resent being taken out of patient work to do the training?" Pogue asked.

"You mean us older doctors, you think, might have been an issue?" Cochran asked.

"I didn't wanna say it," Pogue replied.

"Well, the interesting thing about the more mature, experienced physicians, some of 'em just took to it like that, loved it, fantastic. Others were a little slow. They need a little extra training and support.

"But every one of them will say to you, 'You can never take this computer away from me. I am so happy that I have the information in front of me at all times.'"

The real winners will be patients - and, by the way, insurance companies. But there's plenty of resistance among doctors, who will have to train for it - and pay for it.

Like Dr. Gruss.

"There are tremendous administrative costs and time commitments that doctors have to make at this point, with questionable help to the practice," Gruss said. "We're talking about up to $40,000 per physician, initial costs. So, it's a big hunk of change."

The Obama administration has set aside $46 billion to help doctors and hospitals with the costs to go electronic. But it's a reimbursement. They still have to buy the systems with their own money.

"The question is how to help physicians and hospitals get past that cost," said Dr. David Blumenthal, the President's hand-picked medical-records czar who is there to reassure doctors like Dr. Gruss.

"That's a lot of money that the Congress has put on and the President had put on the table," Blumenthal said. "So I don't think that the complaint about not having help to acquire these records is a fair complaint anymore."

But for doctors, cost is only the first hurdle. Software compatibility is another.

"There are like 60 proprietary programs out there," Gruss said. "And right now, they don't necessarily talk to each other."

"We're developing standards at the national level to make it possible for records to talk to each other," said Blumenthal.

Ashley Katz has another concern, which is pretty clear from the name of her group: Patient Privacy Rights. She's worried about leaks - for example, employers snooping through your health records.

"If we don't put the right privacy protections in place when we're building a large electronic health system, essentially what you're going to end up with is more and more people who aren't willing to tell the truth to their doctors."

"You cannot get the computer into this business without assuring people that their information, their personal information, will be safe," said. Blumenthal. "So we are looking at the best possible technical protections, to privacy and security."

And then there's the timetable. The president wants the entire medical industry computerized by 2014. Even the fans are little worried about that one.

"I think it's probably very optimistic to think you could do something of that size in five years," said Cochran.

In short, there are both supporters and critics of the electronic records plan. But almost everyone agrees on two things. First, it will be good for patients.

"This is really what it's about at the end: It's about empowering the patient," said Quaid. "Because you should be able to have access to your medical record at your fingertips any time that you want."

And second, it's going to be a challenge.

"There's nothing that's worth doing that's easy to do in life, and this is one of those," said Blumenthal. "There'll be bumps on the road. But I think we'll get there eventually, sooner or later."


For more info:
Kaiser Permanents Wins National Award for Technology-Supported Patient Care and Efficiency (Press Release)
National Coordinator for Health Information Technology Named (HHS Press Release)
Dr. Claudia Gruss
Patient Privacy Rights
Dennis Quaid Foundation

[MarteenH]

Docs are resisting the push for electronic medical records because it will not bring any additional revenue stream to their businesses. Let's face it, private practice doctors are businesspeople. More sick patients mean more revenue. Why would they be interested in improving efficiencies, minimizing redundancies, and making an extra expense that would not bring them more money? Wake up America, as long as health care remains a business there is scant incentive to actually improve the health of the patient.

[KarenCor]

It sounds like you need a new doctor. Mine sure don't want me to stay sick and if I didn't get better I'd be seeing someone else!

[PaulAtBoston]

Electronic records could have cost us our 2.5 year old son's life last month. Out of the blue our son started coughing up froth for hours and becoming extremely lethargic, worried that this was an indication that he had aspirated some foreign matter into his lungs (bathwater, gas range combustion by-product, who knows.), we took him to the pediatrician. The pediatrician appeared annoyed that we disturbed his time, said nothing was wrong with him and sent us away. The next day he developed into fever, generating large amounts of mucous, and had more difficulty breathing. We called our medical center's urgent care number to bring him in, but the nurse kept citing the pediatrician's electronic notes that nothing was wrong with our son and denied allowing us to bring him in again. By the next morning our son was in full sever bronchospasms and highly lethargic, something we'd never experienced before. We call a different pediatrician this time and she told us to bring him in immediately or go to the nearest emergency room and do not delay, where he was treated and recovered by 5 days later, but who knows what damage may have been done to the lungs in the interim of non-action. A week later our original pediatrician apologized for not listening to us that there might have been something wrong with his lungs; but I see it as more of a hazard of electronic records than anything. We had to go someplace that didn't have access to the electronic physician notes to get anyone to diagnose and treat our son objectively. It's a real-life, more serious version of the Seinfeld episode where Elaine's doctors kept adding "difficult patient" to her medical records and kept being ignored by other doctors who saw the notes.

[JEngdahlJ]

Are we building a health IT Tower of Babel?

Overlooked in most of the electronic health records discussion is the potential for population-level analysis -- finding healthcare patterns and measuring quality and improvement over time. Only if systems work together via data exchanges or other data pooling can we get the most out of our EHR investment. More insights -- http://www.healthcaretownhall.com/?cat=3

[eastcoastman]

well, we dont want goverments to abuse this like they do a goverment hospitals..the patients at a goverment hospital is treated like a number,or cattle...dont seem to be that care giving loving treatment at those hospitals by their staffs in most cases,people seem to be a number when they call ''next''.....we cant allow this to be abused and treated unhuman!

[eastcoastman]

this can be a good thing if not abused by our goverment...next thing you know we all have to wear one by law,our kids for school,us for work ,and etc....technology can be of good use,but goverment can abuse that technology also...

[EYEDOC43]

WHERE IS THE MONEY FOR ELECTRONIC MEDICAL RECORDS, it is not available anywhere and there are 46 billion, they said available, please let me know because I already spent 250k and I cannot get in line anywhere to apply for this so called money. Its a joke

[tincup356]

I wonder how long it will be before the government passes a law that makes citizens use microchips like the ones used to chip dogs? Big Brother is working hard to control our every movement, thought, and action. I can smell a revolution coming soon.

[AnitaO1955]

Electronic medical records are a terrific idea. However, the fact that records may be accessible online throughout a medical system, does not alleviate the fact that doctors and medical personnel must actually READ the records! On at least three occasions, medical personnel did not read my father's records following a stroke and if I had not been present to monitor his care, the resulting treatment may have proven fatal! And his medical provider is the provider most often cited as the leader in electronic records keeping. Merely reading his chart was all that was necessary.

A friend of mine is allergic to one - count it - one medication (sulfa drugs) and as recently as two weeks ago, was prescribed a drug that sulfa is the basis of. Again, merely READING the chart (that was available online, mind you) would have alerted the doctor and nurses involved.

So, while I embrace the concept, basic human attention is still necessary to prevent medical negligence.

[kirkwood9]

As an ICU RN for almost 3 decades using EMR since the beginning of the year, I can tell you there are many negatives to the system. Many have been stated in the comments already logged on the CBS site. Yes, it does help decrease mistakes but it is NOT a panacea ! Computer charting is a huge time sink taking me away from concentrating on the basics and actually providing care to my patients. We are hearing complaints from patients about lack of face to face time. Managers are up in arms about this,nurses are stressed about being handcuffed to the computer, our nurse to patient ratio is worsening making time charting even more. Who is looking at our accuracy of charting ? Am I getting the right buttons pushed ? I know I am at work many hours after my shift ends finishing charting. How accurate can that be ? Our computer system for charting is the same as Kaiser and it is NOT user friendly. The company did not provide much support at all at the staff nurse level and we are still having huge issues that should have been fixed before the system got to my level. Yes, having those lab/x rays online is nice if they can be found. And how about those sticky notes in every single data cell ? Useless ! Our hospital told us not to use them since the information in them can never be retrieved. Interesting. So it is NOT easy to find info in the EMR,it just sounds like it would be.

[Leelah0824]

Most doctors do prefer paper charts. As a certified medical transcriptionist, I can tell you that I've been with the paperless charts idea for a long long time, but the fact remains that there are MAJOR glitches in the system. Not if, but when, the doctor is unable to access the medical record, there's NOTHING to go on! This actually happens quite frequently. If there are no "old" chart notes or lab values to go on, how is your doctor going to reliably treat you? I've worked in hospitals where the doctors were furious and frustrated because they couldn't tell what was going on, what prior treatments the patient had had, what medications the patient was taking, what happened with the CT scan. At least with paper records your OLD stuff is available should the system go down. Also, you run into many many doctors who are just plain ignorant about how to use computers, but have way too much ego to admit it or ask for help, so they DON'T even try to find the answers they need in the electronic record to give you the care you need. I'm sorry, I don't believe in the electronic record as either a cost-saving or quality of care system.

[ertbsc]

As a physician who has used two different electronic medical records in the office, I PREFER paper charts. I can easily review my patient's history, labs, etc during each visit. This was a cumbersome and slow process with electronic records. ALSO, converting to electronic medical records easily costs an office over $50,000 (not including maintainance). Finally, I saw no reduction in paper waste when using electronic records in the past.

[rocketjl]

One has to admit that errors would be our biggest concern and hackers would be next.

I also believe that the patient should be made to review the entries in medical records. Today, the doctor and nurse write something in the record and then they take the record with them. We don't know what tests have been put in the records and what those tests say. Trust me - doesn't really get it.

[fabrat1]

Yeah my Mom's doctor retired instead of getting trained and buying computers etc. That put her in a hard place. He actually admitted to us that the electronic records was the entire reason he had decided to retire. In just the past 4 months with her new doctor he prescribed 2 antibiotics she was allergic to and the pharmacy was the ones to catch the mistake.

[Void_Master]

I am far more concerned about big brother than I am about hackers. Government at all levels (Federal down to city, precinct, etc.) needs to be prohibited from having, using or even seeking this information. It's just another cataloging scheme for them: a way to keep track of us all.

[tangofred]

Statistically, you're much more likely to be a victim of insurance companies' denial of treatment, job layoffs, bankruptcy, homelessness, and economic recession than you *ever* will be a victim of government using your health record information against you. Rebelling against government may give you some kind of ongoing adolescent identity that energizes you and gives you the appearance of having a value system; but it is a superficial and immature way to think about national healthcare needs. All wrapped-up in yourself, you're a tiny package. Obviously, the "free market" and the insurance industry aren't going to look out for your interests, and other countries have proven that government can be a reliable, trustworthy and competent steward.

[imredeemed-2009]

My husband just spent 5 weeks in a hospital, 2 1/2 of which in the part with the rolling computer carts. I can tell you that they are not all what they are cracked up to be. The hours and hours that the nurses need to spend on those computers is crazy. The personal care of the patients is totally compromised. Also, there were many times that the nurse "forgot" to scan the wrist band or med before giving it, and did it after the fact. How is this going to make things safer?? The bottom line is, it's still a human problem. A computer is only as good as the human that enters the info and the human that is using it. There was one time we actually reminded the nurse to scan the barcodes before the meds were given, that did not go over very well. I'm thankful that my husband and myself were "with it" enough to know that he was getting the right medication, but what about the people who are not?? It's definitely not going to cure all of the problems in hospitals. The only thing that will is hiring nurses that are truly there because they care about people and not just for the money. When you spend an extended amount of time in the hospital like my husband just did, it's quite easy to see the difference.

[janpilot]

I have practiced Critical Care Nursing for >30 years. Do not misunderstand I believe in Electronic Medical Records, HOWEVER THEY DO NOT SAVE TIME for bedside nurses they increase the direct care time by about 30 %. Nurses are increasingly managing care instead of delivering it..a sad commentary on our times

[mediapartner]

My issue with this story has more to do with what happens when a print reporter gets loose on tv... where were the CBS News producers and editors on this important story?

Sitting talking to Dennis Quaid with a wry smile on his face... and then feigning indignation when hearing about the horrible mistake that almost took Quaid's twins lives.... What? Like he didn't hear about that story before doing his piece??

The to have a little fun "schtick" with the scanner as the doctor was trying to demonstrate the computer system.... I mean, if they wanted the story to have a "lighter" side.... why not have David Letterman do it?

A very important story that was handled very poorly in my opinion. A case where probably a decent reporter got a little to enthralled with seeing himself on tv. I what surprised me most is that I would never expect to see that on THIS show. Cable news.... sure.

[jakebuffet]

My oncologist who has electronic medical records...shared with me that pharmaceutical companies are wooing doctors with the electronic medical records software and supplying the computers to run it. She says the cost is so high for doctors without the freebee, but the trade off is that they (the pharmaceutical companies) want access to their clients medical records when they supply this software. Government needs to stop this invasion. So they have reined in the dinners and resort vacations...this is so much worse!

[wburget1]

Any system can be hacked as an IT professional and security consultant there are ways to provide a level of security. HIPAA has strong security compliance rules just as strong as the government security. The issue with all most security breaches happen form within 75% a level of encryption can help aleaviate security breaches but all systems have to be under constant audit as to whether the HIPAA rules are followed

[wburget1]

I am a EHR/EMR Consultant There is no doubt that this will save lives
with decision support capabilities the physician can verify an effective and up to date treatment plan for patients. I am an IT professional who has completed Healthcare Informatics classes and I am a certified medical records sales and service vendor. This is the way to go 144,000 people die each year due to medication errors 80% are due to transcription. With the physician using a temlpate driven CPOE (computer physician order entry) thereis no room for errors this links to a database and evaluates the physician orders and verifys the treatment plan.
Read more about the EHR/EMR system and HITECH Act
ehremrinformatics.com and contact me for information or demo

[ertbsc]

EMR can certainly assist within the hospital but it's not always a solution in the doctor's office. As a physician who has used two different EMRs in the past, I PREFER paper charts. They're faster, more complete, and allow me to be more thorough as I see patients. Electronic records in a doctor's office do not eliminate errors or paper and cost tens of thousands of dollors.