Medical Records

In a 4/30/09 WSJ “Currents” feature, Laura Landro examines the state of medical records at the nations hospitals. Only 1.5% of 5000 U.S. hospitals have full electronic records. The most widespread adoption of electronic records are in lab results where 77% of hospitals show full adoption.

In every other category – medication lists, nursing assessments, doctors notes, diagnostic tests, drug allergy and dosages – adoption is less than 50% of hospitals. Approximately a third of hospitals have started to implement digitization of records.

The Federal Government has “earmarked nearly $20B in stimulus funds ..for hospitals to use electronic records by 2011.” Starting in 2015, the Feds will progressively reduce Medicare reimbursement to those hospitals who haven’t made the switch to digital. For a 500 bed hospital, that could mean a $3.2M yearly loss. By 2015, a hospital could get an additional $6M annually for a fully implemented system.

Part of the problem is the cost of implementing this shift to electronic records. “Hospitals say they haven’t been able to afford the cost of the systems, which range from $20M to $100M.” A disadvantage of these systems are that they are proprietary, making it difficult or impossible for one hospital to share information with another.

A solution is an open source software system, “VistA”, already in place at the Veterans Administration (VA). The downside of this system is that it accomplishes its task, recording and coordinating medical information, but does not have a billing or financial function, which must be added on. Software vendors who sell proprietary systems say that the cost of implementing the VA system with billing and financial add-on modules adds up to about the same cost as a fully integrated system from one of the software vendors.

Recent start up companies which specialize in adapting the VistA system for commercial use dispute that. Medsphere implemented a VistA modified system, “OpenVistA”, for Midland Memorial Hospital in Texas for less than $7M. It’s chairman, a former undersecretary at the VA, says that the OpenVistA system “can be installed in one-third of the time and at one-third the cost” of proprietary systems sold by McKesson and Cerner.

What is the benefit for patients? Lower medication errors and deaths, lower rates of bed sores, and a 88% drop in infection rates, Midland discovered after 18 months of using the new system.
I worked in a large NYC hospital for 6 years, in x-ray, medical records and the ER. Reading the handwriting of some doctors is a learned art, and a mis-reading of a word can be critical.

Some doctors and nurses will resist the change but change it must. As the “Boomer” generation matures, the load on the medical system will increase. Hospitals around the country are fighting a number of challenges to stay viable. Non-profit hospitals have long been a public/private partnership. Now is the time for a public investment in hospitals to achieve some long range goals.

2 thoughts on “Medical Records

  1. Anonymous says:

    When you look at the people at A Homes who go to a number of different doctors at a number of different facilities — and then you look at the massive amounts of medication they take — the old shoebox full of pills — you wonder if one doc has any idea what the others are doing/prescribing. It’s both scary and sad — especially with some of the older folks who trust their docs implicitly — but don’t think to be sure treatment is integrated esp. when it comes to meds. L

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  2. Steve Stofka says:

    Good point. There are privacy concerns so a program to consolidate prescription information should probably be voluntary. A patient could have a card, like a credit card, that would enable a doctor to access all the info on the medications that the patient has been prescribed.
    The “shoebox” prescription management system that some of the residents at Aurora Homes have is scary. Some don’t even know what each drug is for – only what time of the day they take them.

    One resident told me, “the bottles with the green dot on them, I take every four hours. The two with the blue dots, I take in the morning and evening. the one with the yellow dot, I take once a day in the morning.”

    My mother has been very proactive, pestering her doctors to take her off medications. I don’t think many people are as insistent about reducing their medications as my mother has been. the doctors don’t seem to be in any hurry to wean their patients off medication.

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