The bumpy road to electronic health records

San Jose Mercury News (MCT) - When her father fell ill, Dr. Lily Boris faced a mountain of paper: doctors' reports, CT scans, medication lists and lab results, which all had to be carried by hand from the hospital in Fremont, Calif., to a specialist at Stanford, then back to her dad's primary care physician in San Jose.

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"It's the major problem with our current system," said Boris, medical director of the Santa Clara Family Health Plan. "I can go to a bank in Italy and withdraw $400, yet I can't go to the emergency room at Valley because they don't have the same record system."

For decades, health care has lagged behind other industries in embracing information technology. Now, the Obama administration has earmarked $19 billion for health IT in the economic stimulus package, and is calling for widespread adoption of electronic health records by 2014.

Supporters say electronic records will reduce overhead, improve communication and cut down on medical mistakes. Implementing electronic systems could also create thousands of jobs in software engineering, hardware sales and IT support.

But while medical experts are encouraged by the stimulus money, they're also cautious: Creating effective, efficient electronic systems will require a coordinated effort in a fragmented health-care industry.

"The problem in health care is that it's still very much a cottage industry," said Sam Karp, vice president of programs at the California HealthCare Foundation in Oakland. "Just adding computers won't change the way physicians practice _ they need to network with other physicians, labs and pharmacies."

California's share of the economic stimulus money could add up to $3 billion for health IT, according to the HealthCare Foundation. But that money reimburses doctors for systems they've already bought, instead of giving them money upfront to make the initial investment. Additionally, physicians and hospitals must demonstrate "meaningful use" of an electronic system _ which means they can't just enter patient data into a computer, but must also use the computerized data to communicate with other providers _ to qualify for reimbursement.

At the moment, there's no common platform for information exchange. Because each electronic record codes information in its own way, most systems can't communicate. Even if two practices purchase the same software, they don't necessarily use the same coding database, said Paul Tang, chief medical information officer at the Palo Alto Medical Foundation.

"It's like you have two Microsoft Words, but one is communicating in English and the other is communicating in French," Tang said.

Physicians switching from paper to silicon also confront major logistic and financial hurdles. In addition to purchasing an electronic record system, doctors must buy computers, install a local-area network, customize the software and train their entire office staff. Not to mention the task of scanning old records, which alone can take months.

As medical director of the O'Connor Family Health Center in San Jose, Dr. George Kent has spent the last 18 months helping the clinic transition to an electronic system. Converting O'Connor Hospital's three outpatient clinics to electronic records cost roughly $250,000 and involved "an army of people," Kent said, from computer programmers to data entry staff.

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"We had to cut down to half our clinic load for three months," Kent said. "There was a backlog in patients and our revenues went down _ it was initially very inefficient."

Although he doesn't regret the investment, Kent cautions against thinking of electronic records as a panacea.

"Electronic records shouldn't be idealized," he said. "What happens when the server goes down, when the wireless goes down? Before, you could at least look at a paper chart."

To handle technical emergencies, the O'Connor clinic has full-time IT support, and Kent put the number on his speed dial. Last month, he learned that the software company that created the clinic's electronic records is going out of business. In two years, the company will stop supporting the current system.

"You make this $100,000 investment," Kent said, "and then what happens when your company goes belly-up, and it's not compatible with other systems?"

Many large health care providers have already implemented electronic health records and are seeing big benefits.

The computer system supports clinical decision-making in several ways, Tang said, from giving automatic warnings about drug interactions to reminding physicians to order screening tests. Electronic records also let patients take a more active role in their health. With access to their electronic record, for instance, diabetics can get instant access to blood sugar readings.

"The minute they get a blood test, it's in their record and they have access to it," he said. "They can say, 'Oh, I see what happens when I eat this kind of food,' and then all of a sudden they change their behavior."

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© 2009, San Jose Mercury News (San Jose, Calif.).