The Obama Administration's goal to improve the entire health care system in the USA begins with an incremental first step by introducing nearly 500,000 physicians to electronic medical records via the American Recovery and Investment Act 2009. Some physicians, hospitals and clinics throughout the world all ready use some form of health care management software which includes electronic medical record programs.
The focus of the latest efforts is to digitize all existing patient medical records, store the records on a portal which is available to both patient and provider for the purpose of engaging patient participation and of equal importance cut down on medical errors. As with all seemingly benign objectives certain concerns have been expressed on the how, why and where of achieving this primary goal.
The Idea Was Born in Science:
The National Academies is comprised of the National Academy of Sciences, National Academy of Engineering, Institute of Medicine and the National Research Council. In 2007, the Rosenthal Foundation sponsored the lecture series, "Transforming Todays Health Care Workforce to Meet Tomorrow's Demands." The preeminent Harvey V. Fineberg, M.D. PhD and President of the Institute of Medicine and his colleagues set forth a new attitude and direction for medical care delivery which included electronic medical records.
Citing the analogy of Bob Evans, a Canadian health care economist, "before adding more sugar to a cup of tea, make sure you stir the sugar all ready in the cup." The problem of shortages for primary health care physicians, physician assistants and registered nurses comes down to poor utilization of their time. Dr. Kevin Brumback, M.D. Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco says way too much time is being spent by physicians doing rudimentary tasks that someone with limited training or a computer could do.
Dr. Brumback doesn't believe electronic medical records, (EMR) is a panacea for all that ails the health care system, but it will free up time physicians spend reviewing paper files, scheduling lab tests and notifying patients of results. The main point is to bring the patient into the health care system, by putting the health records on-line using a secure HIPAA web site wherein patients could see their medical file, schedule appointments, view lab results and form questions for their next physician visit. The active patient could order age appropriate tests like mammograms, colon cancer screenings and other annual tests.
Other examples of time saving tools include training medical assistants to perform tasks on the medical center's EMR system which is programmed with standing orders, protocols, and lists the type of tests required for the presenting patient. The medical assistant in the "teamlet model" orders labs, inputs data, and creates referral slips while the physician is examining, evaluating and analyzing the patient.
How It Works:
Physicians and medical centers have employed audio-recorder medical record systems for decades. The general method used was to hand-off either written medical notes or audio tapes to a medical transcriptionist who would type up the medical reports and notes. In the last decade or so in order to cut costs, software programs have been developed by the private sector.
Today there are almost 400 vendors that sell EMR software programs with an included HIPPA certified Web portal, 24/7 support, recording units, Bluetooth headsets, microphones and conversion kits. Start-up costs can run over $1,000 for some EMR systems or as little as $150 for the voice-recognition Dragon Speak Medical software available on Amazon. There are high-volume scanners that will scan and upload medical files to the secured Web portal.
Allscripts, a healthcare company has approximately 45,000 physicians using their program. The $18 billion stimulus money allocated by the Recovery Act has vendors tripping all over themselves to lead the pack as the EMR choice. The popular blog EMR HIPPA has its skeptics, critics and enthusiasts. Skeptical about all the forums and marketing currently going on hosted by only a select number of vendors and concerns about after-purchase support and initial set up of the system.
Patients receiving treatment from Beth Israel Deaconess Medical Center, The Cleveland Clinic, Spokane, Washington based 1Health Record, Quest Diagnostics have a leg up because their records are available via a secured Web portal. Patients whose physicians are subscribers to Allscripts may download their medical records. Additionally, CVS and Walgreen pharmacies allow patient/customers to download their prescription history and check for negative interaction of drugs.
Google has developed Google Health application which allows anyone to download their digitized health records to their desktop, hand-held device or laptop. Easy downloads from all the sites mentioned above and a section for your personal information. For a fee Google Health users can hire a service to find medical records. Other services include programs that allow patients to get on-line help for making health decisions, finding medical trials, scheduling medication with alerts and many convenience support tools.
An Incremental But Important First Step:
Any type of change creates some critics both on the physician and patient side. Concerns about confidentiality of medical records may be slightly over-blown. In practice, the HIPPA certified Web portal with access limited to patient and physician is more secure than a conventional medical office. Another big plus is portability for medical care. A patient on a vacation or who moves out of the area doesn't have to worry about consistency in care. If a patient needs a note for his or her employer about a health condition, it could easily be downloaded by the patient from a secured Web portal.
In fact, for a brief time I transcribed medical surveys for several major medical centers. The overwhelming complaint by primary care physicians, ancillary personnel, referred specialist physicians and patients is lags in communication. Primary care physicians want to know what is going on with their patient after a referral and don't want to wait for faxes or find themselves outside the loop of communication.
A universal EMR system would go a long way to improve knowledge, prevent medical errors and keep the physician team and patients informed. The patient as an integral part of the health care system is another advantage of the new technologies. Freeing up physicians to focus on high-level patient services is another distinct advantage of this first step in overhauling the American medical model. The near future could include paramedic access to on-line patient records in emergency situations when time is critical. A subscriber patient could easily carry an access code card in a wallet or on a key ring. Technology as a partner in health care has infinite possibilities for improving patient care.
The Richard and Hinda Rosenthal Lecture: Transforming Today's Health Care Workforce to Meet Tomorrow's Demand, Institutes of Medicine 2007 www.nap.edu/catalog/12079.html
EMR HIPPA Blog: www.emrandhipaa.com/
Google Health: www.google.com/health
© 2009 PhysOrg.com
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