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Electronic Records Translate to Better Patient Care, Doctors Say

In the near future, more medical practices in San Diego County are likely to adopt electronic systems of their patients’ medical records.

Behind the drive is a push by the Obama administration, which began with the previous Bush administration, to have electronic health records for every American by 2014 as a way to improve health care and cut costs. Several local physicians, who already use electronic medical records systems, find electronic record-keeping offers major advantages. Among them, convenience, efficiency, elimination of duplicate procedures and reduction of medical and billing errors.

Dr. John Jenrette, CEO and medical officer at Sharp Community Medical Group in San Diego, said his physicians see the advantages of having a lot of information at their fingertips.

“They can look at prescriptions, which reduces medical errors, and (can look at) laboratory and radiology services,” Jenrette said.

The medical group’s 650 physicians use technology developed by Chicago-based software provider Allscripts-Misys Healthcare Solutions Inc.

Dr. Terry Harrison, a gynecologic oncologist at Kaiser Permanente Medical Center in San Diego, cited three huge benefits of working with Kaiser’s HealthConnect electronic health records system: Convenience, legibility and facilitating good patient care.

“With an electronic record, I never have to search through tattered pages or look for a lost chart,” Harrison said. “The record is always immediately available, including doctors’ and nurses’ notes, lab and radiology results, operation reports, hospital discharge summaries and a quick summary of medical problems, medications, allergies and demographic information.”

In addition, the doctors say being able to share an electronic medical record also helps physicians within their respective organizations provide better care.

“The other advantage of our system is that family practitioners and specialty care doctors can share a common medical record system,” said Jenrette of Sharp Community Medical Group’s system. “So when a physician sees a patient and refers them to a cardiologist, they open the same medical record and can see the same problem list, such as the medication list and medical allergies.”

Communications Network

Kaiser’s electronic health records system allows for communication between physicians, between physicians and other health care providers, physicians and patients, and physicians and the billing department, all of which are part of the vast Kaiser network, said Harrison.

“For example, I can easily review a cardiologist’s recommendations for a patient who is scheduled to undergo surgery,” Harrison said.

Sharing patients’ medical information among doctors is critical and often much easier to decipher electronically, he noted.

“Poor handwriting is never a problem,” Harrison said.

In addition, Harrison feels that electronic record-keeping helps doctors reduce medical errors via cross-checking. According to published reports, as many as 98,000 Americans each year are prescribed medications that they have an allergy to.

“If I order a medication that interacts poorly with another medication the patient is taking, I get an alert on the computer,” he said.

He also feels that electronic record-keeping facilitates a patient’s health maintenance.

“We can easily track patients’ routine health maintenance, such as vaccinations and screening tests,” he said.

But electronic record-keeping is hardly bulletproof.

According to an analyst quoted in Forbes Magazine, on average, it costs $30,000 per doctor to implement electronic medical records systems. The 2009 American Recovery and Reinvestment Act set aside roughly $19 billion to induce health care providers to maintain electronic records in lieu of the paper-based system; including $44,000 in payments to medical practices to adopt certified electronic medical records.

Yet, according to Forbes, as of April 2009 fewer than 2 percent of acute care hospitals had a comprehensive electronic health records system in place. Among physician practices, only 6 percent use fully functional electronic medical systems, according to the National Center for Health Statistics.

Tailored System

Dr. James Ochi, a pediatric ear, nose and throat doctor who runs his own Encinitas-based private practice, Children’s ENT of San Diego Inc., and also performs surgery at Rady Children’s Hospital, said he’s been using his own off-the-shelf electronic medical records system since 1997, citing trust issues with the commercially available electronic medical records systems.

“In my opinion, none of those systems are secure enough,” said Ochi.

He added, “I really felt it was crucial to be in control of the flow of information, and back then, and still today, the e-medical applications go over the Internet, which takes control out of the hands of the physicians and that’s a dangerous thing.”

According to Ochi, the biggest problem with server applications is that doctors won’t know the vulnerabilities, such as security breaches and unauthorized use of sensitive patient data, until it’s too late.

“There are many entities that could use the information against the patient,” Ochi said. “For instance, if medical records are integrated with billing codes, health plans could use the information to raise premiums or turn down a patient for coverage.”

He raised similar concerns about potential employers or certain government entities gaining unauthorized access to electronic health care records.

“When I think about my own medical records, I would feel funny if anyone outside of my physician would look at it,” he said.

Ochi said his patients can rest assured knowing that their electronic medical records are safe.

“The truth is, if someone wants information from me, they won’t get it,” he said. “I don’t transmit any information over the Internet and (if I need to go to the hospital), I can carry the information with me on a password-protected, encrypted USB flash drive.”

He admits that a basic electronic record-keeping system is limiting.

For instance, if Ochi wants to look at imaging studies of his patients, he needs to access Rady Children’s Hospital’s separate electronic medical system over the Internet. He also wouldn’t be able to use his system to order prescriptions, communicate with hospital doctors, or share data.

Barriers To Adoption

Jenrette and Harrison also find barriers within their respective systems.

Not all doctors were happy about making the switch to electronic record-keeping, which takes time to adopt and can interrupt the work flow, the doctors said.

“Not all doctors are enthusiastic about it,” said Harrison.

Training doctors, nurses, technicians and administrators is time-consuming and takes time away from patient care. He said Kaiser invested 20 hours to train him to use the system.

Jenrette said he finds that it can be tough to interact with patients and keep eye contact while typing information into an electronic medical system. Thus, some doctors are still writing clinical notes by hand while sitting with their patients.

Keeping patients’ medical records confidential and secure is a major concern for Jenrette.

“I don’t know of any security breaches at Sharp Community,” Jenrette said.

But, he admits, no system is perfect.

“Systems will continue to be improved as we monitor privacy and security issues,” said Jenrette.

Marion Webb is a freelance writer for the Business Journal.

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