Stimulus to speed shift to electronic files

By Ken Alltucker

The Arizona Republic

Federal money could accelerate Arizona’s push toward digital health records, making staples such as paper charts, written prescriptions and doctor’s-office clipboards a thing of the past.

As part of its stimulus package, the government will pump more than $19 billion into computers and software systems that promise to connect hospitals, doctors, pharmacies and other health-care players.

Widespread use of electronic health records would save lives and money and eliminate waste in the complex world of health care, medical experts agree.

Arizona doctors appear to be adapting to electronic records faster than the national rate, but getting there can be costly and frustrating.

At Central Phoenix OB/GYN, the three doctors and a nurse practitioner started using a digital system in January. The doctors are still learning the system, and the office staff is on the final leg of scanning 20 years’ worth of patient records into computer records. “We are still in the ‘Oh, my God, what have I done’ (phase),” office manager Tracey Vega said.

Arizona’s medical community is poised to collect as much as $500 million in stimulus funds beginning in 2011, local officials estimate, provided health-care organizations adopt “meaningful use” of such digital systems.

“Automation is eventually going to be everywhere,” said David Landrith, the Arizona Medical Association’s vice president of policy and political affairs. Proponents say electronic health records are superior in many ways. A physician can verify a patient’s prescription-drug regimen, helping to avoid harmful drug combinations. Nurses can use a hand-held scanner to zap a patient’s medication to ensure they are giving the right drug to the right person.

Multiple caregivers can simultaneously view a patient’s medical charts, making care more efficient. Still, there are challenges. Some worry that a wide range of computer systems and standards may block effective communication. Systems that cost $100,000 or more are too expensive for smaller doctor’s offices. Comprehensive hospital systems can range from $20 million to $100 million.

Also, worries about patients’ privacy persist.

Arizona’s progress

Studies show varying degrees of adoption rates for computerized records. A New England Journal of Medicine survey indicated that 17 percent of doctors have some type of electronic health-records system, while another survey indicated hospitals’ use of electronic health records vary widely.

Arizona health-care providers have turned to computerized systems at a faster clip, with at least 30 percent of physicians employing some type of digital system, according to Brad Tritle, executive director of the Arizona Health-e Connection, a non-profit group established to orchestrate Arizona’s digital health initiative. Tritle said that figure comes from an ongoing survey of licensed doctors performed by Arizona State University and funded by the state’s Medicaid program.

Arizona’s digital health push isn’t new. While governor, Janet Napolitano signed an executive order calling for statewide adoption of digital-records systems for prescribing drugs. Arizona Health-e Connection has spearheaded the effort to research and develop model policies in the state.

With federal stimulus dollars providing a tailwind, Tritle said he expects the use of digital health records to accelerate.

Digital doctors

Even the biggest backers of a health-information revolution acknowledge that questions remain about cost, training and standards.

Dr. Bradford Croft, a family practitioner in Flagstaff, is one of Arizona’s digital pioneers, having tossed out paper records a decade ago.

Each room is outfitted with a computer. He chats with nurses or assistants via instant messaging. The conversion has made Croft’s practice more efficient, allowing him to see more patients each day. One reason: He doesn’t waste time writing notes only to have others duplicate note-taking several times.

“We’ve been more productive, without a doubt,” said Croft, who also holds an MBA and completed his master’s thesis on the efficiency of his practice.

Yet even Croft said his current system is less than ideal. He has cobbled together eight software programs to get everything he wants. He plans to spend up to $50,000 on a new system. Regardless, he said he cannot imagine going back to paper records. “Does it make us better doctors? Not necessarily,” Croft said. “But I think it makes us more organized, and it makes us more observant to detail.”

Dr. Lesley Johnstone at Central Phoenix OB/GYN said the conversion will make her office more efficient.

One example: A doctor could access a patient’s records and authorize a prescription refill with a few keystrokes rather than searching the office for a paper file.

Plus, the 24/7 availability of patients’ records will allow the doctors to more easily take care of the other doctors’ patients. When a doctor delivers the baby of a patient he or she is less familiar with, it is essential the doctor has access to the patient’s records.

That typically meant a late-night or early-morning call to locate paper records. Now, the on-duty doctor needs only to access a computer. Despite the knowledge that digital records will help make things easier, Johnstone said the transition has not been simple. “It was always really easy on paper, but for some reason, it is harder with the computer,” she said.

Leaders and laggards

Tritle said other areas of Arizona’s health care are considered leaders in digital health, too.

Banner Estrella Medical Center was among the nation’s first hospitals to go all digital when it opened in January 2005. Other hospitals that have established digital records include Banner Gateway Medical Center, Mayo Clinic, Cancer Treatment Centers of America and University Medical Center in Tucson.

One of Banner Estrella’s most recent initiatives is called “positive patient ID,” which aims to eliminate a common medical mistake: giving the wrong patient the wrong medication.

The system works by requiring nurses to use a hand-held device to scan medications to ensure they match a patient’s records. If the nurse has the incorrect room, they will get an alert from the scanner.

The program has cut down on medication errors, said Richard Schmidt, a registered nurse who serves as the hospital’s interim deployment manager. Banner Health plans to roll out such digital-records systems for all its hospitals over the next 18 to 24 months, spokesman Bill Byron said. Banner Health and other Arizona hospitals likely will seek federal stimulus dollars to help fund the transition. “We view this as an affirmation of what we’ve been doing,” Byron said of the stimulus plan.

Above article published on www.azcentral.com.