Printer-friendly format

The health plan President George W. Bush initiated in 2004 to address issues aimed at decreasing medical errors and saving dollars is progressing, although slowly.

In part, his 10-year plan is to create a consolidated electronic health record (EHR) for every American and to build a nationwide network for securely transporting those records. So far, the Department of Veterans Affairs is the only hospital system that has implemented EHRs across the nation.

According to the Journal of the American Medical Association, medical errors are the third leading cause of death in the United States, primarily due to lack of immediate, sufficient and accurate patient data, especially in emergency situations. EHRs promise to decrease errors and cut costs by making records instantly available across state lines, thereby eliminating unnecessary repeated tests and by taking most manual labor out of the hands of those who transcribe the records. Savings resulting from a national system could total half a trillion dollars per year.

In spite of the money EHRs will purportedly save, there are a few drawbacks slowing the movement. Compatibility between vendor software, maintaining patient confidentiality, the cost of tailoring the system for each type of healthcare facility, allocating blocks of time to entering older records, overcoming resistance to change, and ensuring records are kept in an unaltered form and accessible to patients are some barriers leaving systems out on the limb.

To encourage adoption of interoperable health information technology, the president's 2005 budget proposed $50 million in grants to support state and local efforts to develop systems for exchanging health information and another $50 million for continuing research into how technology can improve healthcare quality and safety.

Mike Kappel, vice president of strategic planning of information technology vendor McKesson Corporation, told Computerworld that its price tag to implement the full-scale system could reach $10 billion. Healthcare facilities need big bucks to traverse this financial abyss.

The VA Medical Center system is the exception to the rule. It is one of the few healthcare systems with the infrastructure already in place to implement EHRs. The VA VistA® system began 20 years ago with medication profiles and lab results being kept electronically. Since then, it has added imaging and has become the benchmark for all systems to follow. In fact, it recently received one of seven prestigious Innovations in American Government Awards, sponsored by Harvard University's Ash Institute for Democratic Governance and Innovation at the Kennedy School of Government.

The price of maintaining the VA system is $87 per patient per year, less than the cost of one unnecessarily repeated lab test. In addition to cost savings of an estimated $40 million per year, it has also helped to improve quality of care and patient satisfaction. A recent RAND study found that VA outperforms all other sectors of American healthcare across the spectrum of 294 measures of quality and disease prevention and treatment.

Benefits of the integrated VA system were most recently seen during Hurricane Katrina. Forty thousand veterans evacuated the Gulf Coast, leaving behind all medical records. But regardless of where in the United States they traveled, they were able to continue receiving healthcare, refill prescriptions, and resume treatments. Records couldn't even be retrieved from the VA Medical Center in Gulfport because it was totally destroyed and the New Orleans VA Medical Center was closed. Yet the tragedy hasn't slowed down their care.

Dr. Jessie Spencer, associate chief of medical services at the G. V. (Sonny) Montgomery VA Medical Center in Jackson, said the Computerized Patient Record System (CPRS) system being utilized there is very specific. The turnaround time from entering orders to completion is much more efficient.

"Records are never lost. More than one person can access the record at the same time," Spencer said. "Radiologists now have voice recognition and can record their notes (to) be entered into the system. We can even pull up X-rays on our computer screen and don't have to obtain the actual X-ray. Safeguards have been put into place allowing for patient confidentiality and patient access to their own records to remains high. The records are on a need-to-know basis with not everyone having access to all parts of the records. And, we have two different ways to provide patient records to them. They are legible with no handwriting to try to decipher."

Other agencies are also hard at work attempting to meet the Bush deadline.

Dr. James McIlwain, president of Information and Quality Healthcare in Jackson and a member of Gov. Haley Barbour's healthcare task force, said a Gulf Coast task force has been formed to develop a way to coordinate the electronic sharing of healthcare information between Mississippi, Texas, Louisiana, and Alabama during a disaster.

"We have a lot of islands of technology, and there's no connection, particularly in hospital systems between them and the medical staff. We need to pull it all together," McIlwain said. "The idea is to create a state level coordination that would then exchange needed information with the national structure. Privacy and security are some concerns we have. We're working to develop ways to make sure all is secure and the public can decide where their information goes."


ie.
November 2006

Tags:

None