Techno medicine

The Cleveland Clinic has reduced its consumption of paper in the ambulatory practice from 1,000 reams a month to fewer than 100 reams per month.

An investment in technology made this possible. And while the cost savings in paper won’t fund a major expansion, it is money that is freed up and can be applied to other areas of need. The information that previously was on sheets of paper is now on a computer, where it can more easily be shared and tracked.

C. Martin Harris, a general internist and CIO of the clinic, says this is just one of the many ways technology is improving the delivery of health care.

“We have deployed an electronic medical record that is used by our physicians,” says Harris. “The system makes some fundamental changes.

Using a computer to enter in a patient’s medical information greatly enhances communication. The second a patient finishes a visit, his or her information is available to every physician involved in that person’s care.

“It reduced our dependency on the paper medical record,” says Harris. “Over the last two years, we have transitioned from a model where we moved 5,000 medical charts per day to a model by the end of the year where we will only be moving a few hundred charts per day.”

As of June 1, physicians stopped all printing except for a sheet of paper summarizing the visit that is given to the patient.

“The other side is, when you are documenting a patient’s care directly onto a computer, it reduces our dependence on dictation and transcription,” says Harris.

In the past, doctors either handwrote the information or dictated it to have it transcribed later into electronic form.

“For a large percentage of visits, physicians can do that online directly using preformatted templates,” says Harris.

Typing a few letters brings up a narrative that eliminates redundant reporting. In the ambulatory and primary care practices, dictation has been reduced by about 70 percent.

Technology is also helping keep patients, especially those with chronic conditions, in better contact with their physicians. The e-Cleveland Clinic MyChart initiative gives patients access to their medical records 24 hours a day, seven days a week over the Internet.

“The technology allows us to not only think about the patients when they are here in the institution but also where the patients spend most of their time, which is at home and work,” says Harris. “The value of the system is tremendous from a patient point of view. The provider can communicate and send messages to the patient. The system allows the patient to take control of their health care.”

The system automatically schedules health maintenance appointments, and based on the patient’s condition, age and sex, lists screening activities that the patient should have done.

“A patient can initiate having these activities scheduled rather than waiting for a reminder from a physician’s office that may or may not happen,” says Harris.

Information flows in both directions. For example, diabetics can enter their blood sugar readings while at work and home into an electronic medical record.

“The physician will now have much more information about a patient and their chronic disease than they would normally have without this technology,” says Harris. “My sense is we are just at the beginning of a real revolution in the model of medical practice, where information technology and medical technology are fundamentally part of the care process, and that we will not be able to deliver the high quality care patients expect without it.” How to reach: Cleveland Clinic,