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Health care industry making gradual change to digital recordkeeping

Too often, Leah Stanley shows up at a doctor’s office or hospital feeling lousy. And she must, yet again, detail the 17 medicines she takes.Sometimes she gives up and directs attention to where she has stored the tally of drugs in her iPhone.“It’s like, ‘I’m sick,’ ” said the 50-year-old nursing instructor. “I don’t want to have to tell my story again.”She pines for the day when records collected at one place will, in a flash, be shipped electronically wherever they’re needed. That would certainly make her life easier and avoid the odds of error that increase every time her medical history is re-entered into a computer or on a paper chart.We’re getting there. Government and industry are in the midst of a multibillion-dollar electronic medical records spending spree.So if they haven’t already, your medical records soon will be digitized by North Kansas City’s Cerner Corp. or the many other companies in the business.Just how much and how quickly electronic medical records will help you is less clear.The effort to drag the health care industry into the digital age isn’t yet revolutionizing care, or freeing doctors and nurses from their charting chores. But old paper headaches are being quickly replaced by new electronic anxieties.Instead of problems with sloppy handwriting, records can go awry because of mistaken clicks on a computer drop-down menu. Charts sorted by one software company don’t easily transfer to a clinic using some other system. (For instance, much of Stanley’s medical rundown has been entered into electronic systems, but not ones that move data on the same network.) And recordkeeping is still driven by what a doctor or hospital can ultimately charge for, which isn’t necessarily what makes for the healthiest patient.A $20 billion chunk of federal stimulus money approved in 2009 is helping underwrite the cost of transition to electronic records. Strings attached to that funding are aimed at creating wider access to the records — and the broader health care lessons they may hold.Meantime, doctors and nurses, clinic operators and hospital administrators speak enthusiastically about how computerization of records could improve health care.No more doctors’ chicken-scratch handwriting that leads to someone getting the wrong pill. No more coffee stains to blot out your blood type. No more waiting for a manila folder in transit from who knows where.Now your chronic conditions, your acute incidents, your family history, your prescriptions could be just a click away for the nurses and physicians with your life in their hands.And imagine the bounty of research that could come from the ability to study diseases and judge treatments when hundreds of millions of patient records can be studied through computer searches.Yet concerns abound. Will creating easier access to records for the various clinicians you see endanger your medical privacy? Could competition in the health care industry make institutions reluctant to share information? Could doctors worry that they’ll be judged poorly when records of their patients are compared with those in the care of others?Start with privacy In a world of paper records, we’ve long been vulnerable to someone’s snooping around an unattended file drawer. Such thefts were rare but could often be pulled off without detection. In an electronic world, someone pulling a similar trick would be more likely to be caught. Systems log who gains access to a record. But such thefts could more easily happen on a grand scale. Instead of walking away with a backpack of records, it becomes possible to take off with virtual truckloads.So doctors and hospitals and the vendors who create the systems that store electronic medical records are naturally worried about breaches. And the same safeguards put in place to keep the world from learning you have a history of mental illness or are at a high risk for uterine cancer might make it harder to deliver critical information about your health to an emergency-room physician.“There is always a tension between privacy and access,” said Russ Waitman, the director of medical informatics in the department of biostatistics at the University of Kansas Medical Center.Companies such as Cerner say the problems are solvable. To get access for electronic records at most hospitals, a doctor or nurse typically must first use some physical device to identify themselves to a computer network. In some places it might be a fingerprint scan. More often it’s the kind of pass card used to gain entry to secured parts of a building. After that, they’ll type in a login and password. And if they walk away from the computer, often its software will lock up after a few minutes of inactivity to prevent another person from snooping around the system under the first user’s ID.And, as is the case with paper records, both federal law and institutional policies impose stiff penalties for spying.In clinical care, electronic records can create a conflict between hassle and security. A doctor might have to establish that he’s actively involved in a case to get access to a patient’s record. He might have to enter several commands when consulting on a case by smartphone or other mobile device. Passwords must be more robust.“There has to be some barrier there,” said David McCallie Jr., a Cerner privacy specialist.Making records portableThe Health Insurance Portability and Accountability Act of 1996, or HIPAA, marked the last major update to U.S. medical privacy rules. It changed dramatically the ways in which your medical records were shared. Privacy groups have largely lauded the protections and say the law has given patients important control over their privacy, although some say enforcement has been uneven.But the law was written before medical records really began going digital.Cerner and other electronic records companies say their handling of records goes beyond the HIPAA rules. For instance, the law allows aggregate records to include some information such as the first three digits of a patient’s ZIP code, but Cerner strips away the entire ZIP. And although Cerner’s system will tell researchers that a patient recovered from an illness after a specific number of days, it removes the specific dates so that they couldn’t be used to identify an otherwise anonymous subject.“There are many things that researchers would like to have” — ZIP codes, for instance, can be powerful tools in studying environmental factors in disease — “that they can’t have,” said Mark Hoffman, the vice president of Cerner’s research unit. The company, he said, is erring on the side of protecting privacy.In the early days of HIPAA, critics said, many medical institutions overreacted to the law by being too stingy about sharing information between a patient’s doctors, and even denying patients access to their own records. Privacy, they say, doesn’t have to be entirely at odds with getting the right records to your doctor.“You want to protect privacy and allow data flow,” said Deven McGraw, the director of the Health Privacy Project at the Center for Democracy & Technology. “It’s not either or. It’s yes, and …”Her organization recognizes the promise of medical records, and knows that their potential pays off for patient care best when they are widely accessible to the right people. But she thinks the HIPAA law is outdated, partly because it applies chiefly to the medical industry and not to others who might gain access to data after a privacy breach.It’s not clear, for instance, how it might cover Internet companies that trade in all forms of consumer data. And it’s unclear how the law might apply to health records systems such as Google Health or Microsoft’s HealthVault marketed to consumers.Lillie Coney, the associate director of the Electronic Privacy Information Center, said, “Every time you open up who can have access to data, it’s hard problems.” ‘Meaningful use’The $20 billion authorized to help pay for the shift to digital records also is aimed at developing “meaningful use.” To qualify for the money, a clinic or hospital must serve significant numbers of patients insured by Medicare or Medicaid. And their electronic records must meet rising standards for feeding information between proprietary networks.That sharing of data aims to accomplish two things. First, it would ultimately provide a powerful tool for individual health care — avoiding an overload of one type of drug or conflicting drug prescriptions, or eliminating the estimated 30 percent of laboratory tests that are repeated simply because a clinician doesn’t have access to earlier results.Second, the data eventually would lead to better guidelines on what care is most effective, both at improving health and stretching medical dollars.At Truman Medical Center, the continuing installation of an electronic system purchased from Cerner has reduced emergency-room wait times. The hospital’s chief medical information technology officer, physician Jeffrey Hackman, said it also had given pharmacists more time to study the medication orders because they don’t need to double-check dosages against as many paper records.He said the electronic system also prompted physicians for signs of domestic violence, medication allergies or other things that can get overlooked in a hectic environment.“But it’s definitely a fine balance ,” he said, “of delivering when the clinician needs it and having too many of those alerts.”Officials at North Kansas City Hospital also report improvements in care. For instance, prompts for preventive measures have, in just months, reduced the number of blood clots resulting from hospital care.“There will be a note up for the physician that says basically: ‘Hey, you missed this. Did you mean to order this?’ ” said Paulette Van Dyke, the hospital’s vice president of quality and case management.Expensive systemsElectronic records do change the way nurses and doctors work. Physicians who would commonly tell someone else to record an order typically do the work themselves on computers. Mary Calys, a physical therapist at North Kansas City Hospital, speaks enthusiastically about the potential of electronic records. But she said the technology could come between patient and care giver.“You want to get to the point where you’re not spending the whole time looking at the laptop,” she said. “I can write on a chart when I’m looking at somebody, but it’s different with computers.”Price is another obstacle. Private practices typically pay $30,000 to $70,000 per physician to transform to electronic records and will pay $3,000 to $14,000 in yearly fees after that. The federal stimulus money can offset much of those startup costs, and the elimination of paper shuffling provides a continuing savings.Most of the gains for family physicians — who have been twice as fast as other physicians to adopt electronic records — have been administrative, said Steven Waldren. He heads the American Academy of Family Physicians Center for Health Information Technology.Because doctors still work largely on a fee-for-service basis, Waldren said, “We still get paid based on the volume of procedures we do” So they’re drawn to software that helps them document that work for payment.And although the electronic programs might help improve their care, particularly for patients with chronic conditions, only a minority of physicians so far have chosen to share their records for research. Just 10 to 20 percent of Cerner customers participate in the company’s efforts to build a research database.Meantime, Waldren said, doctors complain about “vendor lock.” They’ve bought service from Cerner, Epic or one of the dozens of other electronic medical record companies. And they’re probably stuck in that system for years to come. And since the different technologies don’t easily share information, said the President’s Council of Advisors on Science and Technology, “it is difficult … to provide accurate information to treat a patient” between doctors and hospitals. Cerner and other companies have developed a system to share records by encrypted email, but that still doesn’t make the charts as available as they are within a network.No more paperAnn S. O’Malley surveyed dozens of physicians about their use of medical records. Without exception, none would return to paper. They ultimately think they’re giving better care, but not at the level that fully networked records might someday deliver.“We want the left hand to know what the right hand is doing,” said O’Malley, a senior researcher at the Center for Studying Health System Change. “But unless you’re on the same system, that doesn’t happen.”Leah Stanley knows that all too well. She has chronic health conditions, asthma and rheumatoid arthritis that riddle her with pain and fatigue. That means she goes to several institutions, all of which need to know of her allergies and medications.Even as she stops at North Kansas Hospital for physical therapy, just across from Cerner headquarters, the records at her outpatient clinic are not yet fully digitized. Those that are still aren’t meshed with those of all her doctors.“You’d think,” she said, “it would be easier.”<hr class="infobox-hr-separator" /> <div class="infobox"> A long way to go •In December, the President’s Council of Advisors on Science and Technology noted that 80 percent of physicians “lack even rudimentary digital records” and said the United States trailed other industrialized countries.•Privacy concerns might have slowed adoption of medical records — and they definitely have curbed their usefulness. It can be difficult to ship the records from one system to another.•Cost also is a big issue. Although $20 billion in stimulus money has helped defray some doctors’ and hospitals’ up-front costs, private practices typically pay $30,000 to $70,000 per physician for the ship. And they will pay $3,000 to $14,000 in yearly fees after that.

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Good Balance Transfer Cards As Noted In Consumer Reports

Health care industry making gradual change to digital recordkeeping

Reduce Credit Utilization With a Balance Transfer | Credit Card ...

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