Health Care In Bits April 13, 2009

CIO Chat

Ed Sperling, 04.13.09, 6:00 AM ET

The health-care industry is a study in contrasts. On one hand, it employs the best that medical science has to offer. On the other, it is one of the least automated sectors from an IT standpoint.

All of that is about to change, however, spurred as much by the federal government’s push for cost control and accountability in health care as the industry’s own need for modern information exchange. The task for implementing those changes will fall on CIOs at hospitals and clinics, as well as the companies that outsource records and information for doctor’s offices and outpatient facilities. Forbes caught up with Geoff Brown, CIO at Inova Health System, a non-profit hospital group in Virginia, to talk about what’s happening.

Forbes: How automated are your IT systems at this point?

Geoff Brown: We’ve been on a construction journey for the past several years. We’re implementing what’s known in health-care jargon as “advanced clinical solutions.” You hear about “computerized physician order entry,” which involve organizations–outpatient groups, physicians, clinics or hospitals–moving away from handwritten notes, charts and prescriptions. On the in-patient side, we’re implementing those changes. The next step will be creating systems where that information will be captured by hospitals.

What kind of information?

When you go to a physician’s office today, you fill out a piece of paper on a clipboard about what medicines you take, what allergies you have, what previous conditions you had, and then the physician writes up those notes. They may have documentation about your condition or state in a problem list. Typically, that information is kept in a medical record within that practice. It is not accessible by any other source unless someone physically makes a copy.

There’s been a lot of talk about the government funding electronic medical records. What’s happening there?

This involves in-patient EMR (electronic medical records) and out-patient EMR in physician offices, which typically are not connected at all. Many offices don’t even have systems to collect that information and provide decision support to physicians. If you need to send that information to a specialist, it’s done by fax or phone, or records are given to the patient to carry over there. It’s all manual and, in many cases, there are interpretation challenges.

What effect will this have on patient care?

I believe it will improve patient care. If you’re a 50-year-old male with a certain illness and you have allergies, I–the doctor–might be busy and forget to look at the chart when I’m prescribing medicine for you. I might not remember you’re allergic to penicillin. When I prescribe this new medicine, it will trigger a warning that this conflicts with your history–because you’re allergic to something or, based on other medicine you’re taking, I should prescribe something else.

So the new systems can help the physician by providing a second check. When you think about 40 or 50 people flowing through a practice during a single day, this can be a significant help.

How about response time for treatment?

That’s a second area where EMR will improve care. Whether those tests are done within a practice or down the road at a lab, you can have access to the results immediately. There also will be a list of drugs maintained by that practice, as well as another level of other combinations of drugs that can be prescribed.

How about a doctor’s handwriting, which is legendary for being illegible?

When someone writes in script and it has to be taken to someone else to enter it or interpret it, there are times when there are mistakes with that translation. You put a big dent in communications problems with EMR. Orders are clear. There are no translation issues. It’s just as the physician intended it to be. Everybody else who’s part of your care process has the ability to access this information, too, so they can structure care. There’s also widespread belief this will save money. When you go from one doctor’s practice into another, they often re-order work-ups because they don’t have access to the existing information. They need to see certain results for themselves before they prescribe a course of medicine.

Let’s back up here a second. Will expert systems also provide the best knowledge available about a condition?

Yes. The term being used is “evidence-based practice.” That’s exactly what it allows you to do. Physicians can still perform a course of action if they know someone is allergic to a drug. They just say: “This is what we need to do.” But electronic records give them a reminder. Doctors aren’t prevented from practicing medicine in a certain way. The software just throws that point out so the doctors can give a reason why they’re taking an action.

Does all of this get reported into a massive database so you can see the probability a treatment will work?

Yes, that’s part of what you see in quality reporting. In most cases, a lot of the electronic medical record solutions have processes like that. The data is aggregated. You can see what the practice is, how your patient outcome compares to the mean, including what the top and low ends are and how you fit within that rating. When you think about all the variations that occur, there’s not a single practitioner I’ve met who doesn’t want to do the best for their patients. If you can provide this evidence-based protocol at the time of service, it’s much like when you go into your e-mail and delete something and it asks, ‘Are you sure you want to delete this?’ It gives you that extra check. Ultimately, we all believe it will reduce errors, improve care, cut waste and time and improve throughput of patients.

Doesn’t this also allow people who are not physicians to follow the prescribed protocol instead of everyone having to wait for the doctor?

That’s correct. The [health-care providers] can create templates. In cases of alleged malpractice, the providers can look at the templates. Here’s the protocol for diabetes, for example. It will eliminate variations among practices. We would be more certain that the same protocol would be followed. If I had two locations where I practiced, all patients would be given the same roadmap.