Posted on Mon, Aug. 10, 2009
last updated: August 10, 2009 05:00:55 PM
SEATTLE — Atop a hill in Seattle, three of Washington state's pre-eminent hospital systems sit within blocks of one another, equipped with state-of-the-art electronic medical-record systems that track test results, send warnings about dangerous drug interactions and provide medical histories.
A patient crossing the street from one hospital to another would be wise to take paper records, however: The systems, made by different manufacturers, can't talk to each other.
For much of the country, linking the electronic records of doctors, hospitals and clinics remains an elusive goal. Even in tech-savvy Seattle, "no one is quite there yet," said Jim Bender, the medical director for health information at the city's Virginia Mason Medical Center.
Among the reasons: cost, computer systems that aren't compatible with rival systems, resistance among physicians and privacy concerns. Overcoming the obstacles, Bender said, "will take federal will and money."
The money is on the way. Under the federal economic-stimulus legislation, the government plans to spend $32 billion on health-information technology over the next 10 years, and projects $13 billion in savings by doing so. Most of the money will go to doctors and hospitals.
There are risks, however. Unless the money is doled out carefully, it "may go down a rathole," said Janice Newell, the chief information officer at Swedish Medical Center, another major Seattle hospital.
That's one of the lessons from the city's experience. Here are more:
MAKE SURE RECORDS CAN BE SHARED
Swedish Medical Center spent four years and $120 million rolling out an electronic medical-record system that links all three of its hospitals, along with the majority of its 40 clinics. However, it can't share data with Virginia Mason or the University of Washington, which is the third big hospital in the city.
Manufacturers have been slow to create systems that work together because they've wanted to emphasize their uniqueness in order to gain market share, Bender said.
To work around compatibility problems, hospitals have figured out ways for their staffs to see some of one another's information. Virginia Mason staff, for example, can view the electronic records of patients served by Group Health Cooperative of Puget Sound, a large HMO, but "it's not a true data exchange," Bender said.
Change is coming. One of the largest makers of electronic medical records has created a way for its systems to communicate with rival products, said Tom Wood, the physician who oversees health-information technology at Swedish. That, he said, will allow Swedish and the other hospitals to "talk to each other" eventually.
Newell, the Swedish information chief, warned that money could be wasted if doctors and hospitals spent stimulus dollars on a hodgepodge of electronic medical-record systems. Instead, she said, regulators should provide incentives for providers "to use existing systems" and then improve technology so those systems can share data easily.
DON'T MOVE TOO FAST
Swedish Medical Center's Wood warned that there are risks in moving too quickly, especially in installing systems that allow physicians to enter medication or treatment orders electronically.
If hospitals rush into installing such systems, "it will kill people," Wood said. "If you don't do it right, physician orders can show up in the wrong place, be confusing or come at the wrong time."
Thomas Payne, the medical director for information technology at the University of Washington, said that his organization now was working on installing computer order entry for prescriptions.
Such systems, he said, have many benefits, but they "also have a risk for side effects." Good programs help doctors distinguish between drugs with similar names quickly and easily, flagging differences between similar drugs by capitalizing letters that differ in the names, for example.
Testing the systems and training staff take time, however, which raises concerns about the 2011 deadline for the first batch of stimulus money, Payne said. Especially in smaller facilities with smaller staffs, "we need to make sure we're giving them time to do this properly," he said.
COMPUTERS ALONE WON'T SLOW RISING COSTS
Advocates say that information technology can save money by making health systems more efficient. Still, bigger savings require more fundamental changes, such as removing financial incentives to do duplicative tests and provide unnecessary care.
"As long as you will pay every time I do that test, the incentive is to do that test as many times as I can," said Stephen Lieber, the CEO of the Healthcare Information and Management Systems Society, a nonprofit group whose members include technology companies. Without changing the way insurers pay for care, "you won't drive costs down."
Payne agreed. "All of this attention on IT is terrific, but it needs to be coupled with reform of the economics of health care," he said.
SOME PROGRESS IS BETTER THAN NONE
Even with its limitations, Seattle — with systems in place in several of its major hospitals — is way ahead of many areas.
Nationwide, only 1.5 percent of hospitals have full electronic medical-record systems, according to a recent report in the New England Journal of Medicine. Another 7.6 percent have basic systems in at least one area of the hospital. About 12 percent of doctors use electronic medical records, the Congressional Budget Office has estimated.
"We don't have to thumb through a paper chart to find things," Virginia Mason's Bender said. "All phone messaging is done electronically, so we don't have waste and harm from lost messages. We've taken the hour and a half delay of getting medications or treatment to patients down to minutes."
So, he said, even though the systems are far from perfect, "there is a tremendous amount of value to create on the way."
EVEN SO, A NATIONAL NETWORK IS NEEDED
David Brailer, who served as the national coordinator for health information technology from 2004 to 2006, said that the lack of a common network — not the compatibility of existing medical-record systems — was the biggest hurdle to widespread adoption.
He likened a network to telephone lines, which tie together various types of phones and communication equipment so that information can move around. Until such a network is well developed for health information, demand for electronic medical records will be slow, even with stimulus money, Brailer said.
"Imagine if companies tried to sell cell phones connected to some networks but not others or that would call only certain area codes," said Brailer, who's now the chairman of Health Evolution Partners, an investment management firm in San Francisco. "The equivalent is trying to get doctors to switch to electronic medical records when they have, at best, a patchwork network to connect to."
(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)
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