Electronic data has been revolutionizing industry for decades.
For those in finance, it makes numbers easier to crunch. Marketers can more quickly determine trends. Journalists can better spot stories.
In health care, electronic information can help save lives.
Take the management of diabetes, for example. Before the computerization of patient records, ThedaCare physicians were unaware of how few of their patients had their diabetes under control. After they started moving patient stats, lab results and other data into computerized records, they were able to crunch numbers and find that only 30 percent of patients with diabetes had blood sugar test results that indicated their diabetes was well controlled, says ThedaCare Medical Director for Information Technology John Barkmeier, M.D.
Recognizing the need for improvement, physicians were able to use that same electronic data to track down diabetic patients who needed additional support. Since then, ThedaCare has doubled the percentage of patients whose diabetes is considered well controlled to 65 percent — the second highest percentage of the 21 health organizations participating in the Wisconsin Collaborative for Health Care Quality.
According to the American Diabetes Association, the blood glucose reading of less than 7 percent is considered "good control." Every 1 percent decrease corresponds to a 14 to 20 percent decrease in hospitalization.
"It was a real shock when we realized how few patients were as controlled as we would like, but if you don’t measure, you don’t know where to improve," says Barkemeier, who still spends half his time as a practicing physician. "You can’t measure without electronic records."
Similar data is used to measure cancer and osteoporosis screenings and cholesterol control.
The potential for improving patient care, reducing errors and decreasing health care costs prompted the federal government earlier this year to include $19 billion in the American Recovery and Reinvestment Act for incentives to health care organizations that convert patient files to electronic records used in a "meaningful way."
Starting in 2011, area providers who meet federally determined criteria will be eligible to receive $40,000 to $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums. After 2015 the carrot turns into a stick, penalizing health care providers for failing to utilize electronic medical records.
National statistics indicate the health care industry has a long way to go when it comes to computerizing patient medical records. According to the National Center for Health Statistics, only 38.4 percent of doctors in 2008 reported using electronic medical records in their office practices. Findings published in the New England Journal of Medicine last year indicated that only 4 percent of physicians have a fully functioning electronic medical record system, while 13 percent have a basic system. Cost and organizational culture are cited as the most common barriers.
The survey published in the journal also showed that primary care doctors and doctors with large practices or affiliation with hospitals and medical centers were more likely to have electronic medical record systems than those who don’t. There is also significant variation by geographic region.
Northeast Wisconsin’s major health care systems are well ahead of the curve. Participants in the Wisconsin Collaborative for Health Care Quality include the Affinity Health System and Aurora Medical Group’s physician groups, ThedaCare, Bellin Health and Prevea Health. Most of these organizations began nearly a decade ago utilizing multimillion-dollar electronic medical record system technology to capture patient data, including health histories, prescription lists and test results.
Between its three hospitals and 22 physician clinics, Affinity Health System alone has records for nearly one million unique patients in its electronic master index, says Douglas Shew, Affinity Health System vice president of information systems.
"I think you’ll find Northeast Wisconsin to be one of the more progressive when it comes to health care," he says. "If you look at the national benchmarks and the state’s numbers, you’ll see we have some of the best health systems in the nation. In terms of electronic health records, we’re probably different than the rest of the country in that there are fewer using them than not using them."
Meaningful electronic records
How health care providers use those records will be a key factor when it comes to determining eligibility for federal funds.
The definition of electronic medical records varies. According to the National Center for Health Statistics, basic electronic health records include patient demographics, problem lists, clinic notes, prescriptions, lab results, and imaging results such as X-rays and MRIs.
A fully functioning electronic medical record system includes the basics, as well as the electronic sending of prescriptions, the electronic sending of test orders and the returned results, electronic medical orders, warnings of drug interactions and out-of-range test results, as well as prompts for evidence-based protocols and interventions.
The federal government is in the process of defining what constitutes "meaningful use" of electronic health data.
While the area’s major health care providers have technology in place, some components have not yet been implemented in most systems. Some of these components will likely have to be in place in order to qualify for the federal stimulus funding.
For example, Affinity Health System has been computerizing patient records since 1998, but like all health care systems it’s working in phases. It is now in the process of fully integrating "clinical decision support," the electronic prompting to physicians to ask questions and run tests based on evidence-based protocol associated with symptoms or known diseases and disorders.
The system also warns physicians if something they prescribe will adversely interact with another medication the patient is taking. It is similar to a medical encyclopedia, but it has interactive intelligence, Shew says.
Affinity also is in the process of reducing transcription work by making changes in physician work flow that include having them input patient notes directly into the computer rather than dictate them, send them to a transcriptionist and then receive them back for review and processing.