Patients charts move toward electronic age

Tarrytown HMO joins national push; doctors concerned

 

Reprinted from The Journal News   

Sunday, August 8, 2004


By Len Maniace
The Journal News


Once he was diagnosed with diabetes in October, John Pomponio relied on the latest in medical tests and the most advanced prescription drugs to bring his disease under control.
It was a different story, though, when it came to the medical records that tracked how the 45-year-old Yonkers man responded to treatment.

That was strictly low-tech.

"In most places, the records are done the same way it's been done for 100 years: pen and ink," said Pomponio's physician, Dr. John E. Jacoby. "Only the handwriting is worse."
While information technology has become a pillar of the economy, dramatically improving productivity, patient records are stuck in an information-age backwater. As a result, medical charts get misplaced, lab results are lost and, yes, doctors' handwritten notes cannot be deciphered.

That may be changing.

Recognizing that electronic records could improve health care and control rising medical costs, the federal government hopes to propel the nation's hospitals and physicians into the electronic age.
Health and Human Services Secretary Tommy Thompson last month announced a 10-year plan to create a "health information infrastructure" that would include electronic health records.

And, in a local push, a Tarrytown-based HMO is encouraging physicians to switch to electronic records for its diabetes patients. Jacoby's New Rochelle office, Metro+Med, is the first of six Hudson Valley doctors offices to convert under a pilot program run by Hudson Health Plan, a nonprofit group that primarily serves low-income patients.

Electronic records, advocates say, could help doctors avert potentially dangerous drug interactions and eliminate some of the fatalities attributed to medical errors, a figure estimated at 45,000 to 98,000 a year by the Institute of Medicine of the National Academy of Sciences.

The cost savings could be significant. Thompson cites a potential savings of $140 million a year, or almost 10 percent of the $1.6 trillion annual cost of health care.

Some form of electronic health records existed in only 13 percent of hospitals in 2002, and in 14 percent to 28 percent of doctors offices, Thompson's department says.

Some of the savings will come from eliminating the need to rerun tests after the original results are misplaced, said Dr. Janet Sullivan, chief medical officer for Hudson Health Plan. The biggest savings, though, will come from keeping patients out of hospitals because they were given better health care, she said.

"Care in the hospital is so expensive," Sullivan said. "And one of the reasons people end up in the hospital is because they are not getting the care they should be getting in the doctor's office."
In addition to Jacoby's office, Hudson Health Plan is converting medical records for diabetes patients at Valentine Lane Family Practice, which has two offices in Yonkers, as well as at three clinics in Sullivan County.

The biggest benefits from electronic records, Sullivan said, are likely to be seen in patients with such chronic conditions as diabetes, heart disease and AIDS, and even complicated pregnancies. Electronic records help physicians keep tabs on their patients, including those who may miss appointments and periodic medical tests.

"Physicians are trained to think about the patient who is in front of them," Sullivan said. "But if they are going to provide good care to all their patients, they also need to think about the patient they have not seen in three years."

To make her point, when Sullivan speaks to physician groups she asks if they know how many diabetes patients they have, a question they almost always can't answer, she said. In contrast, Pomponio's physician, Jacoby, easily comes up with that number. As part of Hudson Health's program, all of Jacoby's diabetes patients have electronic records.

"Two-hundred eighty-six diabetes patients," Jacoby said last week, after a staff member tapped a few keystrokes at a computer.

"Before this, I had no way of knowing how many," Jacoby said. "No way of knowing if they weren't coming in, and no way of knowing if they weren't caring for themselves."
The electronic records can bring together data in graphic form, creating graphs for the important health indicators for diabetes patients: weight, blood pressure, protein in urine and the long-term blood-sugar indicator known as hemoglobin A1C.

"This allows you to see a trend easily," Jacoby said.

A big question remains, however: How does a nation with a huge, decentralized health system of 5,800 hospitals and more than 700,000 physicians switch from paper charts to electronic records?
Though physicians generally see promise in electronic records, the cost worries them.
"Physicians are already facing rising malpractice premiums and increasing office expenses," said Dr. Michael Rosenberg, president of the Westchester County Medical Society. "They cannot possibly be expected to pay for this."

Physicians and hospitals now have to foot the bill to convert to electronic records, Sullivan said, but they are not likely to see any return on that investment.

"The savings are not going to accrue to them. The hospitalizations that don't occur, doesn't accrue to them. It's the health insurers and, ultimately, the government and employers who benefit," Sullivan said.
It's an issue that needs to be resolved, if the effort is to succeed, Dr. David Brailer, the recently named national coordinator for health information technology, said in an interview last week.
"Physicians are on the hamster wheel. If they step off it, their incomes go down. They can't find a way to get past the economics," Brailer said.

For its pilot project, Hudson Health Plan has $550,000 in federal and state grants, some of it to cover the cost of computer hardware and software in physician offices and staff training. Physicians pay the cost of inputting the data.

A major element in Thompson's 10-year plan will be to provide financial incentives to doctors and hospitals to make the change.

As for Jacoby's diabetes patient, Pomponio, digital records make a lot of sense. In his own career, first as a finance manager and now as controller for Acura of Westchester in Larchmont, he has seen paperwork give way to computers.

And he has watched the changeover progress in Jacoby's office.

"He would have to page through the file and it would take a minute," Pomponio said. "Now it's a few seconds on the computer and the information is right there. It's a good idea."