Chicago Doctors Sound Off on a Key and Controversial Switch in Patient Care
You go to the doctor. You sign in at the reception desk and have a seat. There are, of course, stacks of old magazines. There’s usually bad artwork on the wall. And, most likely behind the receptionist counter, there are shelves of tattered paper. You get called into the examination room. The doctor walks in with your chart. Your entire medical history resides in that manila folder.
But now, change is afoot. And that change was the subject of buzz among delegates at June’s American Medical Association annual meeting in Chicago. The days of bad handwriting and torn paper are about to become history. Your medical record will exist in cyberspace, or a computer server. It’s a massive undertaking that is giving many doctors a headache.
“There may be some obvious benefit to patient safety and quality of care,” said Dr. Mitchell Miller, family practitioner. “But it’s that transition we all fear.”
Most health care providers in Chicago are en route to a completely paperless patient record system. As part of the 2009 stimulus bill, the federal government allocated billions of dollars to help doctors switch patient records from paper to electronic.
Many doctors and medical providers say health care reform can’t happen without it.
“The only way to improve quality is to measure quality,” said Dr. Abel Kho, a physician and professor at Northwestern’s Feinberg School of Medicine.
Last year, he received federal stimulus money to help Chicago area doctors make the switchover.
“It’s impossible to measure quality unless the information is electronic,” said Dr. Kho. “It would be like trying to count money in the banks using paper. There are tremendous upfront costs. There’s costs to maintain and support software, there’s training costs and education costs for providers, costs for putting data in, and there are costs because it changes your work flow.”
Even with the federal reimbursement, costs can be especially burdensome for small practitioners.
“Like anything else, you have to spend the time to do it, and time is precious when you’re taking care of a few thousand patients,” said Dr. Miller.
But other practitioners have welcomed the change. Dr. Allison Weathers is a neurologist at Rush University Medical Center. The hospital is almost entirely paperless. She says it improves quality and efficiency of care, because if a patient sees her and one day ends up in the emergency room, ER docs can pull up that patient’s record on a computer.
“Now that we’re electronic, I have immediate access through the medical records to their notes,” she said. “I can see what medications were started, what changes to their history were documented. In the old days, all of that absolutely critical information for patient safety would have been locked away in my office up here, without the ER having access to it. Now we all share the same medical record and everyone has access to that really important information.”
The challenge now, according to health care providers, is sharing the information with competing providers.
“Information needs to follow the patient wherever they go for care across institutional boundaries,” said Terri Jacobsen of the Metropolitan Chicago Healthcare Council.
She’s setting up the region’s Health Information Exchange – an electronic system where competing hospitals and providers can share information.
“There are 93 hospitals in metro Chicago, serving 9.4 million people,” said Jacobsen. “Eighty percent of hospitals have stepped forward to become founding members.”
Some groups, like the American Civil Liberties Union, argue that hospitals are promoting efficiency while risking patient privacy.
“You can’t really turn on the news these days without having another example of a breach of data privacy,” said Illinois ACLU president Colleen Connell.
She says she worries about hackers being able to access hundreds of thousands of records, which could lead to large scale identity theft.
The federal Department of Health and Human Services recently audited electronic medical records technology at a number of hospitals, including one in Illinois. The report revealed “significant concerns” about gaps in security.
Provisions in the federal stimulus package call for tight security controls and aggressive prosecution for violators. Connell doesn’t believe the system works yet.
“There are several incidents of medical identity and insurance theft when someone accesses medical care using your name and information,” she said. “That has profound consequences for the individual involved.”
Connell also believes that, even when the appropriate people are viewing records, it can be uncomfortable for the patient.
“You may, as a patient, not want your foot doctor to know you’ve seen a psychotherapist, or your dentist to know you have problems with fertility,” she said. “There are certain personal facts about an individual that you have a right to keep private, and share only the facts you need to share.”
Northwestern Health and IT specialist David Liebovitz walks a fine line. He is charged with developing a security system for medical records that would make access simple enough so the people that need them can get them, yet hard enough so the people that don’t can’t.
“We have to make it relatively easy for clinicians to get in, but we also have to make it appropriately robust to provide confidence to patients that their information is being safeguarded,” said Liebovitz.
Other physicians have expressed concern with the sheer number of companies out there providing medical records technology, and how to go about choosing the best one.
Many Chicago hospitals — like Illinois Masonic — have already gone completely paperless.
Dr. Shastri Swaminathan, a psychiatrist, believes the electronic patient record has one more obvious benefit.
“Doctors’ handwriting is not always the best, and now people can read the doctor’s prescription,” he said.
Dr. Kho says about half of physicians in the Chicago area use electronic medical records now, and the goal is to get that number to 80 percent in the next two years.
And then the problem becomes: what to do with all that empty shelf space?
For more information, visit the Chicago Health Information Technology Regional Extension Center.