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Time for e-records is now, but it isn't easy

When patients visit an emergency room, they're strangers to the doctors who treat them.

There is no way to quickly retrieve key information from their medical records about medication they take, previous tests, X-rays or allergies.

And when patients return to their regular doctors, there is no quick way for the doctors to check what happened in the hospital.

Until now.

Hospitals, doctors and health insurers here have taken a big step in a regional initiative that will enable them to electronically exchange records of patients and see that information from a computer screen anywhere -- just like bank customers who use different ATMs.

President Obama has vowed to bring medicine into the information age as part of health care reform, saying that it will save billions of dollars and reduce medical errors. His federal economic-stimulus package included $19 billion to encourage doctors and hospitals to use electronic medical records.

But it won't be easy.

Doctors have been slow to adopt electronic medical records, primarily because of the cost. An even greater financial and technical challenge is connecting all the different computer systems and building the digital pipelines to allow patients' health information to follow them electronically to any hospital, doctor's office or clinic in the nation.
Buffalo's system is in its infancy, although further ahead than many others in the nation. The first time it was turned on in an emergency room recently at Erie County Medical Center illustrates how the paperless future envisioned by Obama and others will work.

Dr. David G. Ellis plugged a patient's name into a computer, saw she had been diagnosed with abnormal liver function three days before at a different hospital, and in a few seconds he was looking at her results.

"FedEx can track a package around the world, but we have trouble finding a patient in the hospital. Now we're starting to catch up," said Ellis, director of emergency medicine at ECMC and director of telehealth and health informatics at the University at Buffalo.

>WNY network evolves

In 2004, President George W. Bush set a goal of having most of the country's doctors and hospitals wired to exchange patients' medical information by 2014. The Obama administration has allocated an unprecedented amount of funding for the effort, although it has not committed to the same timetable.

When the federal government embarked on a strategy of building a nationwide digital highway of health information that links physicians, hospitals, laboratories and others, its strategy relied on the emergence of regional health information organizations. The idea is that these organizations made up of local health-related businesses will set up the infrastructure in their areas and eventually be connected into a giant network.

Western New York's regional health information organization, called HEALTHeLINK, began in 2006, although it traces its roots to a start-up group that formed in 1999 called HEALTHeNET. It includes the Catholic Health System, ECMC, BlueCross BlueShield of Western New York, Independent Health, Kaleida Health, Roswell Park Cancer Institute and Univera Healthcare.

This year, HEALTHeLINK launched its system to exchange such patient information as lab results, radiology images, medications and written reports. Doctors without electronic medical records, but with Internet access, can't exchange data but can visit a Web site to find data about a patient.

>Competitors cooperate

One of the most important aspects of HEALTHeLINK, unlike many of the other regional organizations, is that it has gotten competitors to cooperate.

"All the major stakeholders in Buffalo have aligned around an approach that works," said Dr. Michael W. Cropp, chief executive officer of Independent Health and chairman of HEALTHeLINK's board of directors.

Nationally, progress has been slow.

A recent survey found that most of the organizations in the planning phase in 2007 failed to become operational. Few that began operations have been able to broaden their activities beyond sharing basic information. And most of the organizations have not found a way to support themselves without government help.

One problem they all face is that the systems are only worth the time and trouble to use when there are lot of doctors using them and, as a result, records for a lot of patients. Yet only about 10 percent of the nation's hospitals and 20 percent of physicians have adopted at least a minimal system for electronic medical records.

>'There is skepticism'

The cost is high, averaging $40,000 to $60,000 per physician. In addition, to be eligible for federal financial help, physicians and hospitals must use an electronic record system that meets certain standards.

The Obama administration is still in the process of defining what should go in the records and how the records should be used, such as the ability to write prescriptions, exchange patient information and submit reports on quality to the government and insurance companies.

"These organizations are like the first person with a fax machine. You have no one to send things to yet," said Julia Adler-Milstein, the Harvard University doctoral candidate who led the survey published in Health Affairs.

Adler-Milstein notes that the national project's benefits remain uncertain.

"There is skepticism," she said. "You can see the compelling case for these systems improving quality, but not necessarily on the cost side."

The 12 regional health care information organizations in New York State are ahead of the curve mainly because the state has set an ambitious goal of spending $250 million on the projects at a time when most other states are spending less than $10 million each. HEALTHeLINK introduced its system with the help of a $3.5 million state grant, plus financial and other contributions from members.

>A way to avoid errors

"By making accurate and timely information available at the point of care, we can avoid errors and repetitive tests," said Daniel E. Porreca, executive director.

Still, doctors and hospital staff must not only place patient data into the system, which is currently offered at no charge to doctors, but also use it if it's going to have any value.

There are only about 720 medical personnel, including 206 doctors, currently using HEALTHeLINK. The pool of potential participants is much larger -- about 3,500 physicians in the region and 4,500 nurse practitioners and physician's assistants, Porreca said.

Dr. Bonnie Sunday, an Orchard Park family physician, is one of the early adopters.

"Doctors who know about this are excited about it," she said. "But a lot of doctors don't know about it, and it only works if everyone is in it."


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