One of the biggest breakthroughs in medicine is one patients aren't seeing - a complex and costly switch from paper to electronic medical records.
When complete, doctors will order prescriptions and other care online. They'll have instantaneous access from the home, office or hospital floor to laboratory and imaging tests, potential drug interactions, patient histories and suggested treatment protocols for a host of diagnoses.
Physicians also will be able to query the data, allowing them to identify medical trends now hidden within millions of paper records.
Advocates say the electronic medical record will reduce potentially fatal errors and make hospitals and medical practices much more efficient.
"It allows you to practice the medicine of today, not of the past," said Dr. Raul Vazquez, a Buffalo family physician and early adopter of computerized patient records.
The Bush administration has encouraged hospitals and physicians to move forward over the next decade on computerized records while the federal government establishes national standards. Most doctors and hospitals have not yet adopted electronic medical record systems, with cost and complexity of the change being the major obstacles.
Locally, health care providers are making progress. For instance:
* The Veterans Administration Healthcare Network Upstate New York, which includes the medical center in Buffalo, was named among the 100 "Most Wired Hospitals" for 2006 by the American Hospital Association's Hospitals & Health Networks magazine.
* A group of regional health care organizations formed the Western New York Clinical Information Exchange and combined $3.5 million with a matching grant from the state to lay the foundation for a system that will allow them to exchange digitized information, including online prescribing.
* The Catholic Health System is making headway on a multiphase, multimillion-dollar project with Siemens Medical Solutions to install electronic medical records at its facilities, while offering a $350-a-month subsidy to affiliated private physicians who transition to electronic health records.
* Roswell Park Cancer Institute has earmarked $14 million over the next four years to expand its efforts that will soon allow physicians to order treatments by computer rather than by paper. I t's not as simple as installing a piece of software, as you would on a home computer.
For example, a doctor may give a treatment order on paper to a nurse, who transmits it to the pharmacy, which sends the medication to the proper floor in the hospital. With the computer, the doctor's order goes directly to the pharmacist. That's simpler, but it also means new work processes must be devised to ensure that the nursing staff or the next physician to care for the patient knows what has been ordered.
Now, multiply that countless times within all the departments in just one hospital, or across large hospital networks connected to health insurers, researchers and others.
"The challenge of the electronic medical record is making sure we get the right information to the right departments," said Dr. Michael Galang, chief medical information officer at the Catholic Health System.
Moreover, while there are advantages to doctors inputting computerized notes about patients instead of using dictation, the electronic records must be carefully designed so that they record exactly what a doctor meant and can be universally understood by others.
"You have to preserve the quality of a physician's documentation and the physicians' practices," said Dr. Judy Smith, medical director at the cancer center, which is moving toward using templates that can adequately structure the physicians' documentation of patient information.
On a smaller scale, the electronic medical record helps private doctors like Vazquez to lower costs, increase revenue and raise quality.
At his Niagara Street practice, patient information goes directly into the computer at check-in, with data filled into a standard form to reduce the chance of errors and incomplete material. Vazquez and his nurse practitioners type patient notes into handheld digital devices that include common treatment guidelines, such as for asthma and diabetes. Before Vazquez asks a question, he can glance at a list of suggested medications and any potential drug interactions based on that patient's medical history.
He's also combined his electronic medical record with software that automatically calls patients to remind them of appointments, delinquent accounts and with reminders to make arrangements for such tests as colonoscopies.
"Medicine today is high volume. We're all like mice running around that wheel in a cage," Vazquez said. "With the computer, you're able to get off the wheel and take a look around. It covers you."