Electronic patient files to be required hospitals sift through mounds of paper

In an age of e-mail, online banking and the Blackberry, most medical records in the United States are still stored the old-fashioned way - on paper in filing cabinets.

Hospitals and doctors have been slow to adopt the same electronic record-keeping technology that other industries such as banking and insurance have used for years.

But that's starting to change, as the federal government prods the health care industry to come up with a standardized system for tracking patients electronically by 2014.

"From nearly anywhere in the world, we can withdraw money from our bank accounts, pay bills ... and even order groceries online," Health and Human Services Secretary Mike Leavitt said last month. "But, more often than not, we can't share an X-ray digitally, from one hospital to another, even if they are on opposing street corners."

In Sioux Falls, health care providers Avera Health and Sioux Valley Health Systems are moving toward the goal of totally paperless patient records. Both organizations already use systems of electronic health record-keeping - Sioux Valley begins using a system known as Epic this month - but the systems can't communicate with each other and aren't yet part of a nationwide network.

Studies have shown the use of electronic health records could save money by reducing redundant care, speeding patient treatment, improving safety and keeping patients healthier.

But the process to make all those records readily available nationwide is complex, tedious and expensive.

Also, the planned changeover has raised concerns among privacy advocates, and the elimination of paper records eventually could have an effect on related jobs such as medical transcriptionists and couriers.

Barriers to overcome

The issue of electronic records long has confounded the government, health care providers and patients.

The military medical system, including the Veterans Administration, has used electronic medical records systems for years. In large part, that's because of mandates and direct funding from the government.

In the private sector, it has taken longer for health care systems to catch up to the military's way. It's not easy to mandate a complete overhaul in the way patient records are maintained in private organizations, especially when clinicians are the ones responsible for entering vital information, said Dr. David Kapaska, senior vice president of medical affairs for Avera McKennan.

"Doctors in our facility are guests as well as worker bees," Kapaska said. "It's kind of like inviting you over for dinner and telling you that the raw materials are in the fridge -- you cook."

That's a reason why transforming health care providers has been more difficult than in industries such as banking and manufacturing, experts say. While certain elements in the health-care industry - such as billing and scheduling - have been computerized for years, keeping track of patient records electronically is more complex.

Today's patients often don't see one physician for all their needs.

A typical patient might move from provider to provider in different cities, visiting a clinic for a flu shot, receiving a yearly physical at a family-owned practice and visiting an emergency room after a car accident.

For example, a terminally ill cancer patient arrived at Avera McKennan for treatment last month, but his medical records were left behind in file folders somewhere along the Hurricane Katrina-ravaged Gulf Coast.

Doctors treating the patient had no record of prior treatment or even a document explaining basic allergies. An electronic record could have meant faster, more efficient treatment.

"The management of all the data in paper is getting to the point where it's almost impossible to do effectively," said Dr. Dan Heinemann, assistant vice president of public affairs for Sioux Valley.

Sioux Valley's $36 million Epic system is designed to integrate the elements of billing, scheduling, registration, order entry, laboratory, pharmacy and medical records in an comprehensive electronic format.

The change eventually will create an electronic patient record that will follow Sioux Valley patients from clinic to specialty physician to hospital to emergency room. Within the next two years, patients also will have access to their own Sioux Valley health records and will be able to schedule appointments, view test results and more via a Web-based program known as docZ.

Making the pieces work

But while Avera and Sioux Valley now both will use integrated information systems, the systems won't be able to communicate with each other.

For instance, if a patient whose medical information was electronically stored at Sioux Valley is taken to the emergency department at Avera McKennan, their records would have to be faxed or delivered from hospital to hospital.

That's where a standardized national system must come in, said Fred Slunecka, regional president and chief executive of Avera McKennan. Slunecka is a member of a federal commission examining the development of such a system.

"There's a general sense that many organizations would like to have an electronic medical record system, but what keeps them from going forward is that they don't want to make a bad decision," Slunecka said, likening the situation to the development of a videocassette standard in the 1980s. "Nobody wants to invest in Betamax."

Avera Health has used a system called MEDITECH since the early 1990s to combine patient information with laboratory, pharmacy, order entry, billing, scheduling and financial information. While most patient information is now stored in an electronic patient record, Avera is working toward a paperless system where health information is documented and stored electronically at the time of care.

Avera McKennan has in storage on its campus every patient record since 1911, said Dawn Reinicke, Avera McKennan's director of electronic medical records. It's hard to estimate how much space all those records take up, Reinicke said, but the files from just the past four years - laid end-to-end - would stretch 1.5 miles, or nearly the length of the Golden Gate Bridge.

The elimination of paper records will affect the jobs of those who work with those records -- not only doctors and nurses, but also couriers who transport records and medical transcriptionists.

"Those people become editors rather than primary transcriptionists," Slunecka said. "What these people do over time will change. There may come a time (when we eliminate transcriptionists), but I'll be retired by then."

Cost a hindrance

Advances in information technology could make health care more efficient and safer for patients, but it won't come cheap. And privacy advocates worry that the advances could expose patients to ill will if proper security measures aren't carefully implemented.

More accurate records could reduce repeat testing and incorrectly filled prescriptions while increasing opportunities to offer preventative care. But that probably won't save hospitals money in the short run; it could take years for health care providers to recoup their initial investments.

According to a recent study by RAND Corp., replacing paper records with a standardized electronic network would take about 15 years and cost hospitals about $98 billion and physicians about $17 billion.

Medicare would save $34 billion each year as a result, and private insurers would save about $31 billion.

"A major obstacle to investment in health information technology is that those who pay for it don't necessarily experience the savings," said Richard Hillestad, a RAND scientist who led the study.

Both Sioux Valley and Avera said it was difficult to estimate their individual costs and potential savings as they improve their information technology systems.

"All the things in efficiency and cost are important, but the really important part is patient care," said James Veline, vice president of information technology for Avera Health.

"If we could improve patient care and be a wash on efficiencies and cost, we'd all be pretty happy with the results."

Reach Megan Myers at 331-2257.