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The digitization of patients medical records is drawing strong interest from a wide range of sources, from medical facilities hoping to radically alter patient care and existing IT systems all the way to the desk of President George Bush.
In the broadest sense, the move to digital patient records is mandated by new regulatory compliance rules.
But for health care organizations such as West Branch Medical Center in Michigan, the move from paper-based records is a way to improve the speed, access and accuracy of handling records daily.
A key byproduct of the technology, which offers immediate return on investment, is increased patient satisfaction through quicker service, shorter waits and staff members who are more prepared because they have electronic data at their fingertips.
The subject of electronic medical records is also important to Bush, who cited the need to infuse the technology into health care environments during his State of the Union address in January.
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care,” Bush said. “To protect the doctor-patient relationship and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits.”
Despite wide agreement that digital record-keeping is needed, more than 85 percent of U.S. hospitals are still primarily paper-based, according to Rose Harr, president and CEO of BlueWare Inc., in Cadillac, Mich.
Founded in 1993, BlueWare, a software company, provides health care organizations with integrated delivery network solutions through its Wellness Connection suite.
In running its software, BlueWare relies on partners such as IBM and its middleware technology.
What could change the picture is a cultural shift in medicine, similar to what is happening in many industries.
Increased demands
Growing numbers of young, technology-savvy medical professionals are demanding new technology, including digitized records, PDAs and digital signature authorization, Harr said. They want more data faster so they can deliver better, safer health care.
In most hospitals, “all of the information of your previous visits, including your medical history, is in a manila folder,” said Harr.
But that doesnt cut it with physicians who need to make medical decisions quickly, accurately and wherever they are.
“For physicians its very important … to give or receive patient information on a handheld or wireless device,” said Harr, adding that too often a lack of clearly identifiable, readily available patient records leads to retesting, which can raise costs and lower productivity.
Concerns about quality care and finances led West Branch Medical, an 88-bed acute-care facility, to implement BlueWares Electronic Health Record system as a key component in the overhaul of its IT systems.
The upgrade included clinical applications from Keane Inc., as well as IBM hardware and middleware.
“At the time we went to BlueWare, basically all [West Branch Medical] had electronic was a billing process—that was it. Everything else was paper in the entire organization,” said Randy Lewis, IS director for West Branch Medical.
“The decision was made to move forward with an electronic system throughout the entire facility. [West Branch] chose Keane for clinical applications, and they wanted to take it a step further to bring in paperless medical records to have everything archived and put on the AS/400 or on an optical jukebox and burn it to optical platters. That was their goal and philosophy.”
Lewis said the requirements of federal regulations such as HIPAA (Health Insurance Portability and Accountability Act) spurred the medical facility to move to a cross-departmental electronic system.
However, he said it took a great deal of “training and coaxing” to get physician staff members to embrace the technology.
“We were asking them to basically change how they practice medicine, from [paper-based] to electronic,” said Lewis.
“When you consider they went from zero to 60 overnight, I think the staff did a great job. Those who have come on board now love it and dont want to go back.”
BlueWares technology made things significantly easier for busy West Branch Medical physicians who typically have little spare time to learn new application controls, Harr said.
“Physicians can be trained in less than 10 minutes. Theyre doctors, and even though theyre very savvy, they have little patience, and to get 10 minutes of their time is a lot,” Harr said.
“Once we were able to go in and teach them, they really embraced the system. That was a big day for us when the doctors were cool with our product.”
To kick off the nine-month project, Keane was brought in to implement a Hospital Information System strategy featuring patient admissions, billing and financial applications.
The projects next phase included the installation of BlueWares Wellness Connection 3.0 application, which moves information from disparate departmental systems into a common folder.
This can include current information from home visits and visits to a doctor.
“Now the physicians see the [patients] complete record online immediately within BlueWare,” said Lewis. “They dont have to wait for a fax or read an e-mail or receive copies. All lab and radiology results feed across immediately any information they need.”
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That is a dramatic change from how things were, BlueWares Harr said.
Previously, patients who entered the emergency room after-hours would frequently have to wait as a shift coordinator was tracked down, their medical records pulled, and a paper chart and historical information file sought, which was then hand-carried to a physician.
That process can take 30 to 90 minutes. Using BlueWare, that same information can be accessed immediately, resulting in the patient being treated right away.
Even a digital medical-records system cant completely eliminate paper.
But all ER charts, physicians orders and other data that is typically handwritten can be entered into BlueWare via a scanner within 24 hours.
Regarding the technology itself, BlueWare Electronic Health Record features an admission module that lets an attendant scan a patients insurance card rather than photocopy it.
Other modules include scanners that integrate with PAC (picture archive communications) systems, an accounting module, a PDA-attached module and a medical-record module with an electronic signatures capability.
The software leverages IBM tools to create ties between legacy systems and present-day Web-enabled and Web-based systems, allowing users to pool and correlate data.
BlueWare wants to pull in genetic information, as well, through IBM middleware.
For example, it hopes to make genomic information available for heart and lung sounds, said Harr.
A Linux edition of the product, to enable cross-platform support, is expected by years end.
The software provider is engaged with IBMs Virtual Innovation Center to have its technology tested and running IBM p5 Linux servers dedicated to BlueWare.
With fast access to information, PDAs are becoming a more deeply integrated tool at West Branch Medical.
Of 45 physicians on staff, about nine are using PDAs to access medical records remotely or at the health care facility.
Lewis said his IT systems and network infrastructure had to be rebuilt “across the board” to satisfy the new digitized environment.
New hardware at West Branch Medical includes an IBM 810 AS/400 box, as well as an IBM optical jukebox to burn data onto optical platters.
The effort isnt over, Lewis said. He needs to complete his infrastructure to allow the health care organization to roll out more PDAs and enable medical devices to interface with cardiology equipment to save nurses time spent on logging patients blood pressure, vital signs and so on, as well as to take advantage of what on-demand technology can do, such as distributing Keane nightly reports more efficiently.
“The patient satisfaction has definitely improved since weve automated our systems,” said Lewis.
“I approached this as a partnership, and all three companies did that very well.”