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Efficiency At A Price For Local Hospitals
Shared medical records drive down costs, but can community hospitals afford them?
If Senate President Therese Murray gets her way, the state will demand that all medical records in the state are put in electronic formats by 2015, and it will spend $25 million a year to help make it happen.
Dr. John Halamka, the chief information officer of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.Bitter Pill
Experts say the plan could help move Massachusetts toward a system where doctors' offices and hospital systems share their records online, something they say could ultimately save the industry $4.5 billion a year.
But getting all patient records onto computers and building the systems to pass them from one hospital system to another is a complicated proposition.
Efforts to make it happen have already dragged on for decades, stymied in part by the fact that health care providers sometimes find they have more to lose than to gain, economically at least, by implementing better systems.
In recent years, hospitals and doctors' offices all over the state, including some of the small community hospitals of Central Massachusetts, have been converting more of their patient records from paper to electronic files. The practice allows technicians to e-mail the results of CT scans and MRIs right to patients' primary care doctors, eliminates errors caused by messy handwriting and allows better precautions against prescribing the wrong drug.
About half the doctors in the state now use electronic records. That's much better than the national rate of 18 percent, but Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, which works to expand the use of electronic records, said the state number is weighted heavily by the large, high-budget hospitals in Greater Boston. Numbers for Central Massachusetts might look more like the national ones, he said.
Records With Benefits
Even when doctors do use electronic records, most patients lose out on their benefits the minute they leave their usual hospital system to get a specialized procedure. Typically, there is no way to transfer records electronically from one system to another.
At Milford Regional Medical Center, for example, all patient records are scheduled to be in electronic format by the end of 2009. But Linda Rousseau, the director of health information management, said that if a Milford patient had to go to UMass Memorial Medical Center, they couldn't have their records follow them electronically. She said it can even be difficult to share records with the new cancer center Milford opened in partnership with Dana-Farber/Brigham and Women's Cancer Center. Dana-Farber uses different software than Milford. In many cases, Rousseau said, patients have to request their records and pick up a print-out or have them faxed over.
Some patients don't bother, or don't realize they've already had a treatment that the second hospital should know about. That can lead to redundancies, according to Dr. John Halamka, the chief information officer of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. Halamka, who is also the CEO of MassShare, which works on electronic medical records issues in the state, said that, of the $30 billion a year spent on health care in Massachusetts, 15 percent represents redundancy and waste. That includes things like expensive MRIs being repeated, he said.
But Halamka said it's hard to get hospital CEOs and other industry leaders to push for changes that would end up leaving them with fewer revenue-generating procedures.
"One man's redundancy is another man's salary," he said. "So that's a problem."
The Finances Of Technology
Richard Mohnk, chief information officer of HealthAlliance Hospital in Leominster, said the hospital has gone to entirely electronic records over the past five years. That's good for patient care, Mohnk said, but it has meant spending money implementing more efficient procedures that may actually costs the hospital income. If better practices mean a patient is cured faster with fewer procedures, the hospital can charge less.
That's especially a problem when hospitals are reimbursed based on the number of days a patient is hospitalized, Mohnk said. Paying a set amount for curing a patient with a particular diagnosis is a better idea, and one that is catching on, he said, but as the time it takes to handle a specific problem goes down, government regulators reduce the amount hospitals can charge.
Ultimately, Mohnk said, HealthAlliance's best hope is that better performance will improve its stature among patients, and its volume of business.
Mohnk said HealthAlliance has been able to take advantage of government grants to help implement electronic medical records, and insurance companies are making some moves to encourage the practice.
Blue Cross Blue Shield of Massachusetts recently announced that it will require hospitals taking part in its new incentive plan to have physicians enter their medical orders electronically.
Various organizations of hospitals and health care professionals are already working to put the electronic systems into place, but Halamka he said it can be particularly difficult for small community hospitals.
That means that if the state wants to see an integrated system of medical records, one of the first steps is to make digitizing records a joint effort, Halamka said.
Tripathi said Murray's proposal, which would be funded through a cigarette tax, could take such a project a long way. He particularly likes the "carrot and stick" approach, requiring doctors to implement electronic records while offering support to make it happen. But he said it's not yet clear whether the proposal would include efforts to link the records of different doctors' offices and hospitals.
Click here for a web-exclusive story on how Google might revolutionize electronic medical records.
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