Charting a New Course

A patient's wristband is scanned as part of an electronic medical records system. (EN Andrews)
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:

"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."

(AP Photo/Lawrence Jackson)
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.'"


"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