Legible medicine Featured

7:00pm EDT January 29, 2008

How electronic records are taking the guesswork out of health care communication

Pardon the handwriting. Through better technology, this method of medical documentation may become obsolete.

When was the last time you wrote a check for cash and handed it to a bank teller? With online banking, debit cards and global ATM networks, those days are virtually gone. Thanks to advances in information technology, this change is coming to health care, as well — providing convenience and greatly improving safety and patient satisfaction.

Smart Business spoke to MemorialCare President and CEO Barry Arbuckle, Ph.D., to learn how new technologies revolutionize health care, replace today’s reactive care with a proactive patient-centered model focusing on prevention and wellness and offer anytime, anywhere access to information.

What is an electronic medical record (EMR)?

Electronic medical records place a patient’s full medical history onto computers and information systems, allowing clinicians to better coordinate care through immediate access to secure patient data. This facilitates clinical workflows and handoffs — minimizing waste and inefficiency of manual and paper-based processes, maximizing clinical quality through real-time decision support at points of decision-making and eliminating most paper used in patient documentation and education since paper slows care and creates environments ripe for error. Efficient care delivery prevents unnecessary orders and diagnostic tests, reduces medical errors and improves health.

Is this technology new to health care?

Yes and no. Hospitals are laden with technology but are not necessarily automated. For example, many bedside instruments produce vast patient data that must be observed and manually transcribed. EMRs electronically capture, record and trend such data for viewing remotely 24-7 by multiple health care providers.

More than a decade ago, MemorialCare began offering physicians secure remote access and connectivity among our hospitals. More significantly, in summer 2006, we installed a comprehensive new electronic health record and pharmacy module at Saddleback Memorial Medical Center-Laguna Hills just as the Institute of Medicine called for all prescriptions to be written electronically by 2010 to improve patient safety.

Why are hospitals slow to adopt EMRs?

Extraordinary purchase, implementation and maintenance costs are occurring as reimbursement to hospitals and doctors is shrinking [particularly government reimbursement discussed in this Smart Business January 2008 column] while labor, facilities, supplies and life-saving equipment costs are two to three times higher. While EMR inpatient costs for an average hospital run about $15 million with another $15 million for affiliated clinics and physician offices, economic benefits accrue primarily to state and federal government and health plans — not those making the investments. There’s understandable resistance from physicians and caregivers to adopt complicated new information systems.

Implementation requires thousands of hours for physicians and staff and significant changes to clinical and administrative work-flow. More than automating work processes, EMR requires continual review and reengineering to fix inefficient processes and new ways to process, store and retrieve information used every minute of every day.

Is it worth the cost and challenges?

Absolutely. Technology transforms patient care in ways unimaginable under a paper system. At Saddleback Memorial, for example, less than five prescriptions out of 3,000 per day are done by hand. Most patient orders are entered into computers, reducing turnaround time in getting information on the patient chart, making notes more legible, simplifying access to patient information and improving safety and quality.

What does the future hold?

The government’s goal is for all Americans to have a personal health record by 2014. By 2009, EMRs will be implemented at all our facilities. A nationwide network with medical data will follow patients across clinical settings and continents. Empowered consumers will make smarter choices about health care and be knowledgeable about cost and quality of treatments and providers. Treatment decisions will be based on effectiveness, and reimbursement driven by outcomes. Technology helps us realize this vision of health care.

What can employers do?

Partner with local hospitals and physicians to learn how new technologies impact your work force. Advance efforts to establish standards for sharing data among health providers through legislative advocacy. And encourage government, foundations and other relevant organizations to financially support health information technology acquisition and implementation.

BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers (www.memorialcare.org) and chair of the California Hospital Association. He can be reached at arbuckle@memorialcare.org or (562) 933-9708. MemorialCare Centers include Saddleback Memorial in Laguna Hills and San Clemente, Orange Coast Memorial in Fountain Valley, Anaheim Memorial, Long Beach Memorial and Miller Children’s Hospital in Long Beach.