Just a Click Away Computers Are Changing the Way Medical Records Are Kept

When high-tech meets high-touch in the hospital setting, patients benefit.

Proponents of electronic medical record keeping say that’s exactly what’s happening as many hospitals gradually move away from physical files and toward the use of computers to store patient records and place prescription orders.

In the Pioneer Valley, Baystate Medical Center has been at the forefront of that change with its electronic Clinical Information System (CIS). One aspect, the physician portal feature, allows doctors to access up-to-date information about a patient’s status online, from any computer, including at home.

“Our faculty physicians can use the physician portal to check on resident activity overnight and then consult with the residents over the phone,” said Dr. Peter Lindenauer, medical director of Clinical and Quality Informatics. “And community physicians can conduct clinical practice from their remote locations by entering orders into the system. Remote access has been viewed very favorably by the physician community here.”

Hospitals have made other forays into electronic record keeping, such as giving physicians the ability to send prescription orders directly to a pharmacy with no additional layers of transcription, cutting down on the potential for errors.

“In general, hospitals are moving toward electronic medical records for a number of reasons: efficiency, yes, but also safety,” said Mike Zwirko, vice president of Holyoke Medical Center, another facility currently making a gradual transition to computerized record-keeping.

“Say you order a certain medication for a patient, but that patient is already on another medication that may cause an adverse effect. An alert will pop up on the screen. Or say a doctor orders a lab test that has already been ordered by a specialist. It’ll tell you that, too.”

With so many ways computers can be used in medical records – and so many layers to any system-wide transition – the shift toward paperless practices may seem slow. But proponents say it is inevitable – and may even save thousands of patient lives in the long run.

This month, The Healthcare News examines why, at some medical centers, the mouse is mightier than the pen.

A Dose of Efficiency

One critical component of electronic information – toward which many hospitals are now moving – is computerized prescription order entry. Baystate, for example, has partnered with Cerner, a large IT vendor, to develop such a process.

The health system’s clinical information initiative not only stores patient information – such as vital signs, test results, and nursing and physician documentation – but it adds customized alerts to help caregivers provide safer treatment.

For example, “if a duplicate order was placed for a patient, the old system did not have the capability to alert the physician in real time that there was a problem,” said Joan Sullivan, Baystate’s vice president of Clinical Informatics and Reengineering. The new system automatically issues an on-screen alert that notifies the physician of the duplicate order.

Elise Ames, director of information technology at Cooley Dickinson Hospital in Northampton, said many hospitals, including CDH, are moving toward similar systems – which makes sense considering the potential gains in patient safety.

“Drug orders are currently written by physicians, transcribed by secretaries and unit clerks, and physically faxed to the pharmacy,” Ames explained. “The pharmacist then enters them into the system, and the drug becomes available for dispensing; there are a lot of weak links in this process.”

For example, she said, doctors aren’t known for the best handwriting in the world – “a 2 can look like a 5,” she noted – and the risk of a prescribing error increases each time the order is communicated to a new person. Electronic order entry, on the other hand, leaves no room for misinterpreting handwriting.

Furthermore, computer order systems are typically programmed to check for improper doses, known patient allergies to medications, harmful interactions with other drugs the patient might be taking, even whether the prescribed dose is appropriate for the patient’s age and weight – all things a doctor could conceivably miss when prescribing a medication.

The Institute of Medicine released an oft-quoted report several years ago stating that up to 98,000 patients die annually in the U.S. due to preventable medical treatment errors – and certainly some of those are related to incorrect prescriptions.

In fact, the Leapfrog Group, a national consortium of public and private health insurance purchasers, has set three goals to improve patient safety across the board: greater referral of patients to hospitals with the best outcomes, more specialized care for ICU patients, and a move to computerized order entry.

“The Leapfrog Group has been pushing us in this direction, and a lot of the payers, the managed-care companies, are offering incentives and higher reimbursements if we move into electronic medical records,” Zwirko said.

“Allowing physicians to place a drug order into the computer themselves is the holy grail of computerized health care,” Ames said – and should be ready for launch at Cooley Dickinson within a year.

Life Savers, Time Savers

Baystate officials say other elements of electronic information storage have allowed doctors, nurses, and pharmacists to spend more time in direct care, because they’re on the patient floor, not at a desk. “The Clinical Information System enables our nurses to practice autonomously and more efficiently, thus providing better patient care,” said Beverly Siano, a registered nurse and CIS director.

On the nursing units, mobile workstations are wheeled from room to room so that all patient information is at the bedside. Physicians have remote access and can check on patients from their homes, even in the middle of the night if they choose.

Similarly, Cooley Dickinson is planning to implement electronic interfaces for vital-sign monitors, which will save nurses time normally spent charting.

“Say a patient is being monitored for anesthesia or an endoscopy or something like that,” Ames said. “Normally, you would have a nurse charting vital signs, but having computerized links with the vital-signs monitors makes all this automatic. It’s a big time saver.”

Clearly, hospitals have many options when deciding on a plan for electronic records. Zwirko said Holyoke Medical Center has a timeline and a budget for implementation of its system, but it needs to follow a specific plan and make sure the infrastructure is in place to make the transition – for example, the ability to back up all the computerized information in case the system ever crashes.

“We’ve found that some hospitals that have gone to electronic medical records and physician order entry did it all in one shot – and it was a disaster,” he said. “A lot of them put the system up, and it came right back down again.”

Ames agreed, calling Cooley Dickin-son’s efforts “evolutionary,” beginning with making patients’ test results and transcribed reports available to doctors online, so they can access them remotely before seeing a patient later in the day. She said hospitals contemplating sweeping changes to the way records are kept need to do so at a gradual pace and ensure that the entire hospital culture changes, not just technology.

“The downside risk is that, if you don’t change the processes, the staff won’t trust the computers, and they’ll just print out paper from the vital sign monitor, which defeats the whole purpose,” Ames said – at the same time warning that improved efficiency is not always an immediate benefit.

“These process changes don’t always lead to productivity increases,” she said. “At first, nurses might say it actually takes them longer on the computer. But the tradeoff is increased legibility and patient safety.”

For an increasing number of hospitals, that’s a message worth scribbling down.