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Privacy Is Paramount as Health Care Pursues Paperless Records

Since 2009, when the American Recovery and Reinvestment Act put muscle and money into moving health care records and information sharing into the 21st century, the health care industry has moved forward on converting patient records to electronic form.

Hospitals, laboratories, doctors’ offices and other care providers face challenges ranging from the sheer enormity of the task to the paradoxical demands for both accessibility from many points and security that meets the stringent requirements set by the Health Insurance Portability and Accountability Act.

Converting to electronic medical records sounds like a storage solution, a new method for keeping information about health and treatment beyond the color-tabbed manila folders. But it has a far more complicated and useful goal than just putting records on the latest floppy disk.

“The medical record itself should initiate activities to take care of the patient and then have results posted immediately in the record,” said Harris Koenig, chief executive officer of Alvarado Hospital LLC. “It’s not just a repository of data, it’s an active, interactive system that also interacts with other related systems, financial systems, research systems and reporting systems.”

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It’s a huge task. Alvarado Hospital had planned for a cost of $15 million for its six-year project, and the hospital staff was delighted to find Ontario, Calif.-based Prime Healthcare Services remaining committed to the work when the company purchased the hospital in November and was ready to invest in completing the project.

“It’s not just the core systems, radiology, laboratory, pharmacy and the areas that immediately come to mind,” said Eric Logie, Alvarado’s director of information systems. “It’s integrating transcription, nursing documents, care plans, physician orders, lab orders and results, the basic patient information as it unfolds so that the physician’s orders now pop up on a screen in the laboratory and the results are immediately posted in the record, so every member of the care team can see them.”

Massive Amounts of Data

Logie’s team spent 18 months just planning the system, starting with cataloging the records and sources that would have to be included. Designing a system to handle that massive amount of immediate, interactive data was the first step. Designing the record-keeping architecture that would also let the system communicate outside the hospital — while keeping the data secure — was the next challenge.

“The communication within the systems is a huge project and then we have to look at interacting with other systems,” Logie said. “For example, Medicare and Social Security want to be billed electronically so you have to be able to link your systems to theirs seamlessly.”

At Scripps Health, the challenge of turning a mountain of information from five hospitals that count 70,000 admissions a year and a network of ambulatory sites that amass 1.5 million visits a year is enormous.

“We started on inpatient care with EMR in 2003,” said Dr. Joseph Traube, corporate vice president and medical director for information services. “We began rolling out an ambulatory medical record so records are available throughout the system.”

Even while they wrestle to get the proper technology in place, hospitals and health care systems also face the challenge of getting the staff to use the new technology.

“Change in any large entity takes a lot of time,” Traube said. “It’s about changing behavior, making sure individuals who provide care are getting the training they need, the tools they need, the information they need.

“We had to plan our rollouts accordingly,” he said. “How well the records work depends entirely on how comfortable and knowledgeable the people who use them are.”

Extensive Training Offered

Scripps set up extensive and readily available training, ranging from classroom and online tutorials to one-on-one training and designating “super-users” on the floor to whom colleagues can turn with questions.

Rapid advances in technology encompassing commonplace tools such as notebooks and adaptive cell phones have made the reach of electronic medical records vast and less expensive. Dr. Seth Flam, president of the Solana Beach-based HealthFusion Inc., a company founded by doctors to work with medical practices that are implementing electronic health records, said the technology and the certification of standards by third parties makes the whole process easier.

“For instance, the new iPad’s form factor mimics a doctor holding a paper chart, leveraging this advantage and building government standards into the normal physician workflow so compliance with requirements is easy to achieve — and so doctors can earn the available $44,000-$64,000 in government EHR (electronic health records) stimulus incentives,” Flam said, in a written statement. “Providers can look for an EHR solution that provides real-time report cards to track their progress towards stimulus incentive payments.”

With the benefit of immediate communication comes the risk of loss of privacy. Patient records contain much more personal information than any other records, not just birth dates and Social Security numbers but mental health and substance abuse issues, sexual activity and family information. The records will eventually include information over a long period of time, longer than the time span of files such as credit reports.

Flam, as well as Traube and Koenig, said that health care providers are intensely focused on making sure data is secure, both for their patients’ protection and as a matter of following requirements laid out in federal law.

“While it may be frightening for medical providers to exchange information digitally, certifications of electronic health records and their networks by impartial third parties such as EHNAC (Electronic Healthcare Network Accreditation Commission) and ONC-ATCB (Office of the National Coordinator Authorized Testing and Certification Bodies) certification bodies for ‘Meaningful Use’ are helping build more medical provider confidence in digital information exchange,” Flam added.

Challenges and Safety Nets

The systems are being designed to reduce or eliminate errors, add reliability and increase patient safety.

“For example, the nurse charting system assures critical questions will be asked by prompting the users to ask them,” Harris said. “And conditions like allergies to medication or a high potassium level will prompt an alert when a drug or treatment isn’t safe for a patient.”

The job has been made easier by having universal standards and protocols for everything from image quality to connection standards. But not all protocols are universal.

“In health care, there are lots of standards around security but not one big company that set a common standard for everyone,” Logie said. “Different business entities have very different resources, very different requirements and different vendors who call on them and sell them things. There is no one provider.”

While Scripps worked on designing and installing the electronics, they also realized it would spark far-reaching change.

Personalized Treatment Improvements

For the individual patient, it means faster and smoother personalization of treatment.

“Translational medicine brings the laboratory to the bedside — we understand that people vary quite a bit,” Traube said. “For example, some people have genetic traits that make them resistant to certain medications and we can spare them the wasted time and pain of unsuccessful treatments by having their DNA in the chart while we are diagnosing and treating.”

Electronic medical records also mean that data is accessible for research.

“Enterprise data warehousing made possible by EMR means that we can evaluate and analyze health care information much faster and in more detail,” Traube said. “We take information from medical records and de-identify it to protect patient privacy, and we can measure what works and what doesn’t, for example in diabetes management programs.

“For example, we have real-time syndromic surveillance — if we see a spike in emergency room visits with flulike symptoms, we can track it immediately and take steps to be better prepared, notify epidemiologists and take preventative steps much faster based on very current data and evidence,” Traube said.

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