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Medical care charts moving from filing cabinets to computers

Dr. Rick Wilde fills out an electronic chart on his laptop during a routine physical for the 
9-month-old Aaron triplets. Physicians are moving from the use of paper to electronic charts.

ATOYIA DEANS | Times

Dr. Rick Wilde fills out an electronic chart on his laptop during a routine physical for the 9-month-old Aaron triplets. Physicians are moving from the use of paper to electronic charts.

In the next five years, the government wants to outfit every person in the United States with an "electronic health record,'' a plan backed with $19-billion in economic stimulus money.

Moving medical records from paper charts to computer screens marks an opening shot in the new administration's ambitious agenda to reform health care. President Barack Obama says the new technology will help "reduce errors, bring down costs, ensure privacy, and save lives."

Some doctors in the Tampa Bay area already are making the switch to electronic records. Their view from the front lines helps explain the controversy over a digital transformation that holds great promise, but also great concern about how Americans' most private information is safeguarded.

Security, cost, reliability of the software — doctors and patients can find many reasons to be wary. Dr. Rick Wilde, a Lutz pediatrician who has been carrying a laptop into examining rooms for more than two years, once shared those worries. But now he's a convert.

"You have the ah-ha moment. The first time you're not sending staff all over the building looking for a paper chart is priceless," he said. "We can't lose anything any more."

From the front lines

A little over a month after going digital, paper charts are piled high on the chairs, floors and desk in Dr. Emily Perkins' office in North Tampa. Nothing about this transition has been clean.

These days, she lugs both paper charts and a heavy, new laptop into her patient exams. Everything takes longer. Between the "stick out your tongue and say aah's," she searches for boxes to click on a screen. She dislikes having to turn her back to patients to type into the computer.

"I'm actually seeing fewer patients right now, because I'm learning the system. So we're having to turn patients away, which is bad," she says. "I feel like I'm back like a new pediatrician, starting over, which is very frustrating."

During the transition, her patients can visit one of the Pediatric Health Care Alliance's other 12 locations in Hillsborough, Pinellas and Pasco. Perkins' site is among the last to go digital, a conversion that has taken the alliance nearly four years to implement and cost in the $1 million range.

While the learning curve can be steep, many doctors who made the switch say they would never go back.

Dr. Wilde works in the alliance's office in Lutz in Pasco County, one of the first to go online. He says patients are thrilled when he electronically transmits prescriptions to their closest pharmacy.

Wilde also likes how the computer automatically checks his dosages against a child's weight. And it's easier to keep track of after-hours visits, when other physicians treat his patients.

When the 9-month-old Aaron triplets came in for a regular checkup recently, he knew about their emergency visit last weekend to the pediatric group's Brandon location. They all had come down with pink eye.

"I saw the note. So they all had the crud?" he said, greeting their mother, Cristie, with a smile.

She really likes the convenience of knowing that she can visit any of the alliance's offices, and her children's health information pops right up.

"They also give me really good printouts of the measurements and everything so I can keep track, because I wouldn't remember," said Aaron, who has to keep the triplets and her 3-year-old calm during the doctor's visit.

With a click, Wilde can also update the triplets' growth charts to reflect how their weight and height compares to other premature babies. Before electronic records, such graphing was done by hand.

"It allows me to monitor the growth more precisely," he said. "I think we make less errors with the plotting and less errors with immunizations."

Dollars and sense

One day, the government envisions health information flowing over a vast national network. Have a medical emergency during a vacation in Michigan? No problem. A physician there could access your records.

Just as any electrical appliance works in any wall outlet across the county, there now is a need for technology standards ensuring the electronic health record system at one hospital can talk to another provider across town.

The federal government is working on how to make this happen, a process that is also building up from the local and regional level, said Jane Horowitz, chief operating officer for the National Alliance for Health Information Technology, a nonprofit representing stakeholders from hospitals to health information technology consultants.

For doctors and hospitals, stimulus money amounts to a carrot, to be followed by a stick, intended to bring them online. Today, as few as 1 in 6 physicians have even basic electronic health record systems, according to the New England Journal of Medicine.

Still, technology is only as good as the people using it. Clicking a wrong button can be easier, in some ways, than writing down the wrong prescription.

"The truth about electronic health records is that, even though the president really wants everyone to have one, they are not ready for prime time," said Dr. Deborah Peel, a psychiatrist and founder and chairwoman of the Texas-based Patient Privacy Rights, a leader in a coalition that lobbied for safeguards on health information in the stimulus bill.

They include allowing patients to request an audit trail of electronic disclosures of their health information. The stimulus bill also requires that patients be informed of any unauthorized use.

Industry supporters point out that people have become comfortable paying bills and managing financial information online. It should be no different to give physicians better access to critical health information.

But concerns linger over how well anyone, from a doctor's office to the electronic record vendors, can secure our most sensitive and personal data.

"The day when somebody hacks the big mother ship or the big system is going to be an interesting day," said Michael Igel, an attorney specializing in health care law with Trenam Kemker in St. Petersburg. "You're talking about medical records here."

Spending and saving?

The government's billions are sure to accelerate a feeding frenzy among vendors seeking their cut of stimulus cash. Locally, doctors may not be prepared to navigate it.

"It's a train wreck getting ready to just crash in the biggest, hardest way because the physicians are not educated," said Anissa Raiford, executive director of the Pinellas County Medical Association, which last week launched the first of four lectures in a series on the topic. "We still have doctors who don't want us to e-mail them any information. They just want us to fax."

And now the University of South Florida is seeking to take a lead in converting physicians to electronic prescribing, considered a first step to a comprehensive electronic health record. Its corporate partner, Allscripts, offers the e-prescription software to doctors for free — but hopes, of course, that doctors will want to buy the bigger package.

"Sometimes you can do well by doing some good," said Glen Tullman, chairman and CEO of Allscripts, describing e-prescriptions as "the on-ramp to the electronic medical society."

The Department of Health and Human Services says the adoption of health information technology will reduce health costs for the federal government by $12 billion over 10 years.

How? The technology could lead to fewer medical errors — and less spent to treat them — and care that is both higher quality and more cost-efficient. Advocates also believe it will help patients and doctors manage chronic conditions before they become expensive emergencies.

But others say the potential savings to the system are exaggerated. Certainly, many local doctors getting a jump on the transformation don't expect to make money from the investment.

St. Petersburg physician Fadi Saba said his seven-doctor practice in internal medicine, Professional Health Care of Pinellas, received quotes between $150,000 and $400,000 to convert to electronic health records.

It drove down the cost to less than $100,000 by teaming up with other doctors in the same position. But for all the research time and effort already invested, the hardest part is coming in the transition in a few weeks.

"It's a mixed bag. In the long run, we know everybody is going to go with (electronic health records) because it basically gives you easy accessibility to medical records no matter where you're at — and that's priceless when you're taking care of a critically ill patient," Saba said.

But he noted it will take time to convince every doctor. "Physicians usually are very resistant to change. They are set in their own ways, they want to do things the way they used to 10 or 15 years ago."

Times researcher John Martin contributed to this report. Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit health.tampabay.com.

Medical care charts moving from filing cabinets to computers 03/21/09 [Last modified: Monday, March 23, 2009 9:44am]

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