SCARBOROUGH, Maine — Dr. Barbara Slager recently received a panicked telephone call from one of her patients.
The pregnant woman had undergone an ultrasound at a Portland clinic that showed that her baby wasn’t growing normally.
The frantic patient called Slager, her obstetrician at Coastal Women’s Healthcare in Scarborough, who immediately called up the woman’s electronic medical record on a computer.
After verifying herself as a clinician through a statewide health information exchange called HealthInfoNet, Slager was able to view the ultrasound results and put the finding about the baby’s growth in perspective.
Overall, the ultrasound results were positive, she assured the woman over the phone.
“Ordinarily I would have had to call the office and say, ‘Can you send that report over? The patient’s hysterical on the phone,’” Slager said.
Coastal Women’s Healthcare, an independent gynecologic and obstetric practice, has converted all of its 10,000 patients to electronic health records. The practice was honored Thursday by federal officials for its leadership in transitioning from paper to electronic records and for meeting federal criteria for “meaningful use” of digital records.
Andrew Finnegan, an official with the Centers for Medicare and Medicaid Services in Boston, said the practice’s embrace of health information technology will reduce costs and improve patients’ health.
“You’re doing a great job saving us money,” he quipped.
Electronic health records have been hailed as a way to improve health care by putting patient histories at clinicians’ fingertips, as well as allowing doctors to track when patients are due for preventive care and help them to better coordinate treatment for people with chronic illnesses.
Their adoption has been spurred by federal stimulus funds that provide incentive to health care providers — many who worry about the hassle and expense of converting — to wean themselves off paper. Over the next decade, the federal government will dole out $27 billion to hospitals, doctors and other providers that show they’re committed to using electronic records.
At Coastal Women’s Healthcare, adopting digital records cost the practice about half a million dollars, Slager said. That was partially offset by $110,000 in incentive payments the practice has received this year, she said.
Nationally, non-primary care specialists like those at Coastal Women’s Healthcare have lagged in adopting electronic health records. By 2011, more than half of all office-based physicians were using digital records, but only about a third had systems with basic features, such as the ability to view lab results and manage computerized prescription orders, according to a study published in the May issue of the journal Health Affairs.
Three years ago, about 50 percent of Maine hospitals and 40 percent of physician practices in the state had adopted electronic medical records, said Shaun Alfreds, chief operating officer of HealthInfoNet.
“Anecdotally, I’d say we’re closer to 75 percent or more adoption [today],” he said. “All of our hospitals, all 39 hospitals, either are currently on a certified EMR or in the process of implementing.”
Physician practices are proceeding at about the same pace, Alfreds said.
“There are still some small practices, especially in rural Maine, that are not affiliated with a health care system or a community-based health care group … that I think are still struggling a bit, and it’s mostly due to financial issues,” he said.
Some research has pointed to potential pitfalls of electronic health records. A November study by the Institutes of Medicine found that well-implemented health information technology can improve patient safety, while poorly designed systems can create new hazards.
Medication dosing errors, failure to detect fatal illnesses and treatment delays because of glitches or loss of data have led to several reported patient deaths and injuries nationally, the panel of researchers found.
The panel recommended requiring vendors to report such incidents to a national database and more oversight by the public and private sectors.
There are penalties for not adopting electronic medical records.
The patient was, without a doubt, completely comforted and reassured by the standard of care offered over a telephone. “Overall the ultrasound results were positive.” “Overall?” And, isn’t “positive,” the negative in medicine.
“… a panicked phone call” deserves a face-to-face. And, how about letting the patient see the images, too. Send them as an email attachment.
If this story was meant to impress – it has failed to do so.
So which is it, have the perfectly fine and healthy patient come right in for a soothing face-to-face (while other scheduled patients are forced to wait) or send the patient the images via email? Some people are not happy no matter what, but are unable to offer a rational solution to what they see as a problem.
HealthInfoNet has been way ahead of the nation’s adoption of EMRs. It is a very well-run program that is, in my opinion, the gold standard for integrated EMRs.
This is really just a matter of semantics, but HealthInfoNet isn’t an EMR. It is the central medical-related information database in Maine, and it serves as an information exchange for healthcare providers who use a compliant and connected EMR.
The reason this distinction is important is because patients should know that just because their doctor uses an electronic medical record keeping system, it doesn’t necessarily mean their records are currently shared with the HealthInfoNet clearinghouse (though it is extremely likely if your doctor’s practice is part of one of the big systems–MaineHealth, Martin’s Pount, Mercy, etc.). The reverse is true too (you can opt-out of having your data shared, even if your doctor uses an EHR).
Thank you for clarifiying that.
A “perfectly fine and healthy patient.” is not one who is panicked. Nor is it one who is pregnant and has other than a “normal” ultrasound. The answer is this: throw those pesky, never-happy people out of medical practices. Viewed as such, they’d be better off.
“Gold standard.” Translation: The standard that brings in the most money. The method/procedure to look to when a practitioner has no idea how to approach a problem. “Well, let’s go with the “gold standard” for this. Sometimes, one just doesn’t know.
I’m going to assume that women are receiving sonograms frequently these days with pregnancy. Why. Is there a reason why women should have them throughout if no problems are perceived. Is the patient in the article panicked because she did not need to have a sonogram, but because sonograms have become some kind of standard of care.
The patient needed to be seen, and, she needed to be shown the image. But did she need the sonogram at all? Do you honestly believe that this woman, and the fetus, are healthier because she is frightened. Again, “overall” things looked good. What didn’t. The woman is left with that.
Ten years ago, I had an image taken of a potentially problematic area. The recommendation was biopsy. I had had a thorough evaluation of that area by another physician in a very distant state, where I had been living. It wasn’t easy, but that new image was presented to the original physician, along with a thorough update of symptoms, and current lab results, who made the call that there was nothing that indicated surgery. That opinion was then shared with the new physician who concurred.
There was no network. There was me, wanting the guy who had done the thorough evaluation to be in on this ‘new’ development. There was also the non-medical person who worked for the original physician who went above, beyond, and around, I will say, standard regulations in order to accomplish this collaborative effort, and, of course, the physicians themselves who were willing to take a chance on this early, rebellious? version of electronic records-sharing — and, the technology people at the hospital where the original workup had been done. Should they have gone to so much trouble and risk? Both physicians had complete documention down the line. Now, this sort of collaboration is sanctioned. One big difference is that I was part of the process.
Blame this mess on the article if you want., which sounds like an ad, that is, until the mention of the errors. But before I close this off, I would like to know if key participants in care – laboratory cytologists and pathologists, radiologists, etc., are given any patient medical history, whether on paper or electronically, (except in case studies), that include lists of medications and use of supplements and herbs, so that they can give their best diagnosis. If even this is not yet the “gold standard” of care, then that needs to be addressed before all the glom and glory of the illusion that is invested in all things electronic.