Electronic health records: making medicine better or worse?

These days, everything is going digital – music, movies, books. So it’s no surprise that hospitals and doctor’s offices around the country are converting to electronic medical records. In theory, doing away with all those manila folders filled with patient papers should improve hospital efficiency and care. For those who make the transition, there’s money to be had too.

President Obama allocated about $20 billion in the stimulus package to help doctors adopt electronic health records. Here he is in the year after he took office, speaking about his interest in the technology.

PRESIDENT BARACK OBAMA: I spoke to the chief information officer here at the hospital and he talked about some wonderful ways in which we could potentially gather up electronic medical records and information for every child not just that comes to this hospital but in the entire region, and how much money could be saved and how the health of these kids could be improved. But it requires an investment.

When the president spoke those words in 2009, less than 2% of hospitals met federal government requirements for electronic medical records. Transitioning is a time-consuming and expensive process. Now, there’s a new push to make it happen.

On January 3, the federal government re-opened registration for hospitals and individual doctors interested in using federal money for digitizing their records. KALW’s Sindya Bhanoo reports.

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SINDYA BHANOO: Meet John Birch:

JOHN BIRCH: I’m a general dentist. I live in Mountain View and I’ve been in this location for 35 years as a dentist.

Dr. Birch is also a self-professed lover of technology.

BIRCH: I could have easily gone in to computer science or physics or maybe just been a typically EE and done a PhD in electrical engineering.

So he uses a lot of technology in his personal life.

BIRCH: I have a daughter down south, and I figured if anything happened to me, she would need to know where my stuff is. So instead of having it in a drawer I have it all on a website and she has the access code, and that way I’ve kept it online rather than in a drawer.

But like many practitioners set in their ways, Dr. Birch has resisted moving over to electronic health records. He has his reasons.

BIRCH: Inertia, old school – I’ve just sort of done it this way. Probably if someone showed me how easy it could be, it were turn key, I’d be open to it. More of it, is just habit.

So even though he’s eligible to receive about $44,000 from the federal government to help him transition to electronic health records, Dr. Birch plans to stick to using paper and manila folders for his 500 patients. But around the Bay Area, other practitioners are making the change. Late last year, the City of San Francisco decided to invest $10 million into digitizing health records at San Francisco General Hospital and all of the city’s public health clinics. That means the medical information for hundreds of thousands of San Franciscans will be digitized within the next three years – something the city couldn’t afford to do before the federal stimulus money became available.

DAVE COUNTER: The majority of our payments come from Medicaid.

Dave Counter is the Chief Information Officer for the San Francisco Department of Public Health.

COUNTER: Medicaid only pays you 60 cents on the dollar. So consequently if 80% of your revenue stream is always being funded by Medicaid, you’re always running a deficit. So consequently we never have enough money to even support ongoing operations. I find, I always have to do more with less … the city’s got a $400 million deficit, all my positions are frozen and here’s all this stuff we’ve got to do. The stimulus package allows us to contract with the vendors with the software.

But Counter says installing electronic systems doesn’t mean health care in San Francisco is going to get more efficient – yet.

COUNTER: One of the things that you think is that the productivity is going to go with all this computerization, but just the opposite happens. As they’re using this stuff online, their productivity drops off, it takes them more time, it will probably be two or three years for us before we can get the productivity stabilized and being able to optimize the use of these systems … I think that that’s one of the challenges.

He says another challenge is just convincing doctors to use them.

COUNTER: There’s resistance to it: “I’m the doctor, I find I’m much more productive; I see the patient, I go in there and I just write my doctor’s order in the medical record, and then it’s the doctor’s problem.”

ALBERT CHAN: I think it is an ongoing challenge for us, those of us who help implement and support these records.

Dr. Albert Chan works with the Palo Alto Medical Foundation, a large Bay Area health care provider. His organization transitioned to electronic medical records more than a decade ago.

CHAN: These systems are very complex. There is a steep learning curve … many physicians never achieve more than 20% of facility with the features. It’s not as simple as saying, “Let’s put in these systems, turn it on and we’re done.” We’re learned over the years that we have to continually go back and educate our physicians about new features and even optimize existing features to make them better users.

Today, the Palo Alto Medical Foundation allows patients to access their private health records from their own computer. Family members can link their records together, view their test results, make appointments and renew prescriptions online.

CHAN: The ability to have that data available to you, the ability to be able to share that with patients so they can be partners in health – that is transformational. Do I think we need to move this way as a nation? I think the answer is yes. Can it enable or even the playing field for patients, patients with health disparities for example? If you can provide transformation health technologies and give those tools to patients, regardless of economic class, I think the answer is yes.

Someday, before he retires, dentist John Birch says he might get around to digitizing records for his 500 patients.

BIRCH: I’m old! (laughs) So I tend to do something the old-fashioned way. But if I want to do something electronically, I’m also an HTML coder. I could probably say, “See you later, dear,” and go do it over a weekend and I would own it myself. And I know how to do that – most dentists don’t know how to do that.

Of course, to get their data digitized, they don’t need to know how to do that. The government will help pay someone else to do it.

In Mountain View, I’m Sindya Bhanoo, for Crosscurrents.

Sindya Bhanoo has a Kaiser Media Fellowship in Health and is examining how privacy is affected by new developments in health technology.