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Electronic Health Records Gain Steam

New York, NY (Sep 25, 2009)

Female doctor at computer

Technology is intimately woven into the practice of medicine today: Doctors use nuclear imaging scans to diagnose many diseases, computers to guide precisely targeted radiological treatments and surgical procedures, and sophisticated electronic devices help disabled people get around and communicate. But most doctors still record the details of their encounters with patients on paper forms and file these among thousands of others in racks of manila folders. Patients, on their side, fill out similar forms again and again, and usually leave the office with a paper prescription in hand.

Stimulus Package Aids Movement

Through a $19 billion infusion into the health care system, part of the $787 billion 2009 stimulus package, the federal government aims to change the way patient information is stored and managed, said Rainu Kaushal, MD, MPH, the Chief of the Division of Quality and Clinical Informatics at Weill Cornell Medical College and an Associate Attending Pediatrician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Some money is being administered presently, while the bulk of the funding, which will be paid out to doctors and hospitals through Medicare and Medicaid incentives, is likely to begin being dispersed in 2010. These incentives are designed to encourage hospitals and private doctors' offices to adopt interoperable electronic health records (EHRs) – detailed histories of each patient's interactions with the medical world.

How Electronic Records Would Work

Healthcare providers will use EHRs to capture a person's entire medical history including doctors' notes and documentation, all medications and allergies, vital signs over time, immunization status, radiology and laboratory test results, and billing information. EHRs will need to be "interoperable," said Dr. Kaushal, which is key to enabling different health care systems to share a patient's electronic data. When a patient visits the emergency department at the local hospital, for example, the doctor there will be able to access patient's clinical information from their primary care doctor through interoperable EHR. "These tools promise us the ability to provide safer, higher quality care more efficiently to each individual patient," said Dr. Kaushal.

Dr. Rainu KaushalDr. Rainu Kaushal

Electronic prescribing, too, should improve medical care. "There is good evidence that electronic prescribing improves the safety of medication use," said Dr. Kaushal. Electronic prescribing not only eliminate problems with illegibly written prescriptions, she said, but also alert doctors and pharmacists to all of the medications a patient is taking, even those prescribed by several different doctors. This information will help doctors choose the appropriate doses and frequencies and should prevent adverse drug events including those caused by drug-to-drug interactions. "Some of the most advanced systems incorporate information about what medications a patient has actually gotten filled at their pharmacy, so there is additional data about what a patient is doing when they leave the office," Dr. Kaushal said. She pointed to the difficulty doctors have controlling patients' high blood pressure. "We often will continue to escalate their doses of medication to try to achieve better control. But sometimes the patients are just not filling the prescriptions. If we know that we'll be better equipped to manage the patient."

Some hospitals including NewYork-Presbyterian are beginning to add a feature called patients portals to their web sites. Patients can log on and view their clinical test results, send them from one physician to another, find out what medications have been prescribed, the timing and dose of these, and potential side effects. Some web tools allow doctors to communicate with their patients through secure web channels, which should cut down on the number of office visits, and reduce the waiting time for patients who need to see doctors in person.

A Good Start, A Way to Go

Despite EHRs' many advantages, less than 10 percent of US hospitals and 20 percent of doctors now use them, said Dr. Kaushal. A significant barrier to EHR adoption, she said, includes the upfront and operational costs of these systems. "There is also a certain amount of natural physician resistance to change, confusion about how to choose the best system, and a lack of appropriate technical support."

New York Takes the Lead

The stimulus money from the federal government should help change that, she said. Doctors and hospitals in New York are already benefiting from the state's hefty investment in health information technology, said Dr. Kaushal. New York has already allocated about $250 million for electronic health records that can connect health IT systems to each other through the statewide health information exchange network. New York is the frontrunner with an eight-fold greater investment than the next leading state. Dr. Kaushal is helping the state evaluate the effectiveness of its funding as leader of a multi-institutional academic collaboration called HITEC (Health Information Technology Evaluation Collaborative), which includes investigators from Weill Cornell Medical College, Columbia University, and the State University of New York at Albany.

Contributing faculty for this article:

Rainu Kaushal, MD, MPH, is the Chief of the Division of Quality and Clinical Informatics at Weill Cornell Medical College, and an Associate Attending Pediatrician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

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