The goal of creating a national, standardized database of electronic medical records (EMRs) continues to be elusive, despite the founding of the Office of National Coordinator for Health Information Technology by President Bush three years ago. The main reasons for this are the enormous costs and complexity of such a system and the concerns of privacy groups about possible misuse of the data.
In the Hudson Valley, hospitals are struggling as it is to find the money to make their EMRs more user friendly, extend the digital technology to more functions and create a network of interconnectivity with other health-care providers.
One thing is clear: hospitals”™ IT departments have become permanent fixtures, as the systems continually need to be upgraded and tweaked.
Crystal Run Healthcare, a group of 120 physicians with seven locations in the Hudson Valley, is ahead of the game: It has had an EMR system for eight years, which was a significant factor in its ability to expand, according to chief medical information officer, Dr. Gregory Spencer. “A large part of why we could grow so effectively is because we have online access all the time to patients”™ charts,” he said.
Yet the center still has “tons of challenges” in maintaining the system at an optimum level, said Miguel Hernandez, director of IT at Crystal Run Healthcare.
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Buying into change
A big challenge is the continual process of finding the middle ground between what works best from the IT perspective and from the doctor”™s point of view. “Doctors are very reluctant to change their processes,” said Hernandez. “Unfortunately, computers force you to conform. We”™re trying to get physicians to do more than just the basics.”
For example, the group”™s NextGen EMR software has templates with drop downs to view select pieces of information about a patient. “Some doctors won”™t click on all of these,” said Hernandez. But it”™s a process that”™s improving: “As we get the newer physicians, they”™re more acclimatized to EMRs and it”™s less of a challenge.”
Hernandez said the IT department also works to change the templates to fit better with the doctors”™ natural work flow. “Sometimes we have to manipulate them. Some doctors would prefer the format was laid out differently. And new physicians have a new outlook on the work flow. We”™re always in a state of change and constantly modifying” ”“ such as to reduce the number of clicks a doctor has to make.
Hernandez said Crystal Run is attempting to create more interactivity with the patient records at its partner hospitals; however, usually the document is sent as an electronic fax, rather than in a seamless electronic interface. “One of the challenges in IT in health care is that though these systems are progressing and evolving, they”™re still proprietary and don”™t always talk to each other.” The ideal scenario, he said, is having a single database accessed by typing in a patient”™s name or Social Security number, which would ensure health-care providers always have access to the same data.
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Working out the bugs
Obviously, protecting patients”™ privacy is a serious concern. Besides layers of security, Hernandez said Crystal Run “constantly does mandatory education with employees. We have a very strict policy on violations. If you access something you”™re not supposed to, you”™re out. We still control it. People may have access to the system, but there are limits.” Theft of sensitive data on a laptop isn”™t an issue, since the EMRs are in a central database rather than on the portable computers; physicians use their laptops mainly to access the database remotely on the Web.
Patients can request their medical records, which are put in PDF format and burned onto a CD. “We”™ve been looking for ways to make that information more portable,” said Hernandez.
“With technology anything”™s possible. It”™s a lot harder to achieve than just figuring out a way for us to better share information with local hospitals. The bugs are not worked out yet.”
Through its membership in the THINC Regional Health Information Organization, Spencer said Crystal Run was helping to create “more community-based availability of data.” This would decrease unnecessary duplication of services for the patient, speed up care and also decrease bureaucratic and administration overhead. “Right now, you have to bill 15 different insurance companies and set up 15 different pathways. We”™d like to create a common language so interfaces could chat with each other to use this common data set,” said Spencer.
The expense of creating national standards in EMRs has been a stumbling block for the government. There has been progress: A certification process for EMR products has been set up under the Certification Commission for Health Care Information Technology, a nonprofit established by the government in 2005. Last year, the first certified EMR products were released. The certification paves the way for more interoperability in the future.
“Right now, there”™s the care on the ground, in the office, which we have been very successful at. The next step is enabling the different practices and medical centers to share the data so we can talk to each other in a real-time way,” said Spencer.
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