Digital Doctors

By Diane Ballard

Patient health records go paperless

For years we’ve heard about the promise of electronic health records or EHRs. They will improve patient care, reduce costly duplicative procedures, involve the patient more completely in his or her own care, and ultimately save money. But when?

Right now, University of Tennessee experts say. The benefits are beginning to accrue — and will continue to as the gargantuan U.S. health-care establishment slowly embraces the future. Yes, there are issues: cost, security, physician resistance and the sheer size of the undertaking. More than 800,000 physicians and 5,700 hospitals aren’t likely to adopt EHRs without some turbulence.

UT Medical Center in Knoxville (UTMCK) has achieved “meaningful use,” the technological foundation upon which more advanced pieces of the EHR structure will rest. It was one of the few hospitals in Tennessee to have qualified as of the end of 2011. The federal HITECH law allows physicians and hospitals to earn financial incentives from Medicare and Medicaid if they demonstrate adoption and meaningful use of certified EHRs in a series of three stages. Providers that don’t adopt EHRs will eventually receive reduced Medicare payments.

“Achieving meaningful use means we have the systems in place to move on to such things as online prescribing, online medical notes and other advances that will put the patient at the center of the process,” says Dr. John Beuerlein (HSC ’95), UTMCK’s chief medical information officer.

Already the hospital has seen savings in such areas as radiology, which is now “filmless,” and in medical transcription, where physician dictation goes directly to an electronic document. Buddy Fain, the medical center’s chief information officer, says physicians get patient data more quickly and accurately with electronic systems.

“Turnaround time is faster, and orders are clearer,” says Fain (Knoxville ’74, ’77). “Many test results are available instantly.”

Dr. Diana Cobb with UT Family Physicians in Alcoa, Tenn., seconds that statement. “Lab test results used to come into my office over the fax machine, and we reviewed them on paper. Now results show up electronically in my inbox.”

Cobb (Knoxville ’97, HSC ’01) has been using EHRs since April 2011 and says it has taken some getting used to. Locating documents electronically rather than in the paper charts was cumbersome at first.

“One of the greatest hurdles was getting used to not looking at paper,” she says. “But technology has helped tremendously in the ability to review lab results more efficiently, which improves patient care. I can get prescription requests quicker and refilled more effectively. Also, prescriptions are sent electronically, which helps ensure accuracy.”

Growing Demand for Health Information Professionals

The push to adopt EHRs has upped the demand for health information professionals. UT’s College of Allied Health Professions in Memphis is a major supplier of graduates in the field. Dr. Rebecca Reynolds, chair of the Department of Health Information and Informatics, says online degree options have boosted the number of graduates.

“Since moving the curriculum online and offering the post-graduate master’s, we have experienced tremendous growth. Our students are typically professionals working in health care. They come to our program seeking to make systems work better to support patient care.”

One of Reynolds’ department’s graduates, Amanda King, works in Jackson, Tenn., at the tnREC Support Center helping physician practice groups adopt health information technology. King says the major hurdle for physicians is the up-front cost. “Even though providers are offered an incentive, it’s still a large investment,” she says.

Not only do physicians have to spend a lot for technology, but in the short term, their productivity sometimes declines, says Dr. Randy Bradley, assistant professor and health-care information technology strategist with the Physician Executive MBA program at UT Knoxville. As doctors and their staffs struggle to familiarize themselves with EHR systems, work flow may slow, and attention that might have gone to patients is instead focused on how to use the system.

The progression to EHRs appears inevitable, and eventually paper medical charts may seem as quaint as bloodletting with leeches. To get through the transition, it’s helpful to remember that technology is only a means to an end, an effort to ultimately improve patient care.

“Technology isn’t the issue,” Bradley says. “The issue is infusing technology into the (health care) system.”

Beuerlein sums it up: “People and process are the hard parts. Technology is just a tool.”

Points at Issue

In addition to the front-end cost of health information technology, other sticking points slow the adoption of electronic health records (EHRs).

Alert, alert.

Systems automatically alert physicians to take certain actions. The alerts can be time consuming and, by some accounts, irrelevant.

Who did what and when.

Technology tracks every alert and every action. That’s good for patient care but holds health professionals to a higher standard of liability than traditional paper records that were less inclusive.

Results are in.

But should patients see test results in real time if they show serious diagnoses such as AIDS or cancer? Many doctors believe patients should only receive sensitive information from their physicians, who can interpret the results and recommend a course of action.

Is this really necessary?

Some physicians see EHR systems as needlessly time consuming and hard to use. Generally speaking, younger doctors, who have grown up with technology, are quicker to embrace the systems.