Electronic patient records at heart of improved safety

November 20, 2011
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Ensuring across-the-board patient safety and quality of care in hospitals, doctors’ offices and community health clinics is a complex, ever-evolving strategy — or at least it should be, say local health care experts. That’s why many consider electronic medical records crucial to reducing patient fatalities and errors and averting medical mishaps that could result in costly litigation.

Most health care providers agree electronic medical records were increasingly gaining ground before President Barack Obama signed into law two years ago the Health Information Technology for Economic and Clinical Health Act, which was part of the American Recovery and Reinvestment Act of 2009.

The HITECH Act’s intent is to foster a nationwide electronic exchange of health information that is intended to improve quality and coordination of health care by investing $20 billion in health information technology infrastructure and use Medicare and Medicaid incentives to encourage doctors and hospitals to use EMRs to exchange patients’ health information.

The HITECH Act stipulates that eligible doctors may receive incentive payments for the first five years (2011-2015) by demonstrating “meaningful use” of certified EMR technology. Physicians who have not demonstrated meaningful use by 2015 will receive reduced Medicare reimbursement payments by 1 percent each year.

The overall goal is to get most, if not all, on board the EMR train. In 2018 and any year thereafter, if industry-wide adoption of certified EMR technology has not yet reached 75 percent, a provider’s reimbursement may be decreased by an additional 1 percent.

HITECH also authorizes incentive programs through the state Medicaid program to Medicaid providers that demonstrate “meaningful use” of certified EMR technology.

HITECH incentives are a carrot-stick approach to coaxing health care institutions and doctors’ offices that may have been sitting on the fence to implement EMR systems, said Dr. Gregory Forzley, chief medical information officer for Saint Mary's Health Care and medical director for Advantage Health. The initial start-up costs are far more than the government’s reimbursements, and the turn-around time to learn the new technology can be disquieting for doctors and hospital administrators who usually see a momentary reduction in patient volume until the learning curve hurdle is cleared.

“Almost everybody will tell you it costs more to adopt this system,” said Forzley. “You definitely have to pay for the technology and then teach your staff how to use it and maintain it efficiently in taking care of patients. Your ability to see the same volume of patients goes down, which affects your business model, and you will not be able to sustain your business model.

“Yet, one of our partners is happy with adopting the electronic records. He has a professional scribe who goes into the exam room with him, and while he’s examining the patient, that scribe is inputing information and preparing it for him to review. That means they’re paying for a person they didn’t use before.”

Despite some health-care providers’ misgivings, electronic medical records use will grow, particularly now that U.S. health care reform is moving closer to a nationalized health care system. These are compelling reasons that Cadillac-based BlueWare Ltd., an international health care software corporation, recently released Version 6 of its BestBond electronic health record software so it can interface with a broader range of databases, said Kaitlin Welliver, marketing manager for BlueWare.

“BestBond was originally developed for only IBM servers, but you can imagine with databases skyrocketing, not everyone wants to buy IBM,” said Welliver. “Some want to run HP or another servicer, so we added much more functionality.”

“We’re very enthused about what’s happening in the United States,” added Welliver. “We’re excited from what we’ve learned from the U.K.’s national health system. They’re also coming out with new legislation or procurement processes.”

The HITECH Act’s intent follows a goal then-President George Bush declared in 2004 that every American should have an electronic health record by 2014, calling for public and private sectors to work together in defining and building an information network that would support the secure exchange of health data across the United States. In 2005, the U.S. Department of Health and Human Services commissioned the HealthCare Information Technology Standards Panel to assist in developing the National Health Information Network.

Forzley said there’s an important distinction between electronic medical records and electronic health records. EHRs allow a freer exchange of patients’ medical history between hospitals, physicians and clinics, regardless of geographical boundaries, software platforms and proprietary rights.

“Electronic health records are set up to share that information once they’re given secure access to their records,” said Forzley. “Access to that information is important because if I see something that looks funny or irregular, I can raise the question to someone else who may be a specialist: ‘Is that right or what does that mean?’ We want to adopt something that is my own propriety but we’re able to share. Most electronic health records are being built that way so they become something they can share across the secure wires.”

EMR and EHR software is vital to patient safety and enables health care facilities to avoid lawsuits because the older system — using hard-copy paper — can cause unintended mishaps, said Mark Pawlak, Holland Hospital’s vice president of ancillary services and quality.

One reason for that is EMRs keep a multitude of doctors, specialists and departments on the same page. Digital patient records include a range of data in comprehensive or summary form, including medical history, prescribed medications, allergies, immunization status, laboratory test results, radiology images, vital signs, billing information and personal stats such as age and weight.

That’s a boatload of information, but EMRs keep busy health care staff on track, said Pawlak.

“Electronic health records are based on the idea nobody can know it all and it’s unrealistic for humans to keep track of it all,” said Pawlak. “We need systems to provide information at the time they need it.

“Health care is still a person-to-person interaction and there are so many opportunities for errors to occur,” continued Pawlak. “The more systematized we make that process, the less chance there is for human error to occur. There are many examples where electronic medical records can take the variability out of the system and remove opportunities for mistakes to be made. Electronic medical records capture information. They can allow you to evaluate your performance on various levels that I believe has helped the health industry to improve itself.”

Pawlak said backing up the hospital data in case of power failure or natural disaster is a “big deal” for a health care institution.

“So for us, we have not only backups that are stored offsite but have duplicates,” he said. “We have two data centers in the hospital in different locations at completely different ends of the hospital, with duplicate equipment to support key clinical and financial systems. We have an entirely second self-supporting system back-up onsite and offsite.”

EMR is far and above a better method than the paper charts some clinics and hospitals still rely on, said Dr. Jean Nagelkerk, Grand Valley State University’s vice provost for health.

“With paper charts, it’s all documented on paper records where you might have them in different divisions, different sections of hospitals and different nurses’ notes, doctors’ notes, lab and, at the top of the chart, all the patients’ routine medications,” said Nagelkerk.

“And you’re always looking for those charts. It could be (in use by) a physician or a unit clerk or a secretary, so there was a constant searching for the charts.

“Another benefit is communication. You quickly look at the document and go online and see who made the last entry, and it’s easy to search. Another benefit to electronic health records is they provide medication alerts.”

Even though EMRs have been around for about two decades, there are kinks that need to be worked out, said Nagelkerk. There are a multitude of EMR software options that do not always interface with one another.

“There’s more than one electronic health company out there, and not all of them communicate well back and forth, so that is going to be a challenge if you want one hospital to interface with another,” said Nagelkerk. “The other challenge is the way they’re structured. Some have different-looking screens, all of them are not organized the same, some are easier to input data (into) and others can be more complicated. Yet, the goal is easy access of information and reading the more important parts of the patient’s treatment plan when providing treatment care.”

Clearly, health care watchdogs believe there’s room for improvement. The Boston-based Lucian Leape Institute at the National Patient Safety Foundation, for example, last year issued a report that finds U.S. “medical schools are not doing an adequate job of facilitating student understanding of basic knowledge and the development of skills required for the provision of safe patient care.”

The institute’s findings come more than 10 years after the Institute of Medicine’s 1999 report “To Err Is Human,” which found that 1 million people are injured and 98,000 Americans die annually from preventable medical errors. The report attributes some of the errors in patient care to a “medical ethos” that discourages teamwork and transparency and undermines the establishment of accountability for safe care.

Among the IOM’s recommendations: Share knowledge and information freely, which EMRs can make possible. EMRs are not a panacea, the IOM report adds. A stronger cooperation among doctors and institutions must be fostered so they actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.

“Despite concerted efforts by many conscientious health-care organizations and health professionals to improve and implement safer practices, health care remains fundamentally unsafe,” Dr. Lucian L. Leape, chair of the institute, said in a statement. “The result is that patient safety still remains one of the nation’s most solvable public health challenges.”

In the institute’s view, a major reason progress has been so slow is that medical schools and teaching hospitals have not trained physicians to follow safe practices, analyze bad outcomes and work collaboratively in teams to redesign care processes to make them safer. These education and training activities need to begin on the first day of medical school and continue throughout the four years of medical education and subsequent residency training, according to the institute.

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