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Doctors Slowly Going Digital With Records

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Connie Grimstad doesn't need to call her doctor's office when she has a question about the slew of medications she takes daily _ the 57-year-old homemaker simply delves into her medical records from her home computer. As the medical industry moves slowly to replace its paper files with electronic versions, people like Grimstad are light years ahead of most doctors.

She's among about 10,000 Americans who've made the leap with a free online service that permits anyone to create their own electronic personal health record _ and access it anywhere via the Internet. With a few keystrokes, everything's there: the details of her prescriptions, health insurance records, diagnoses and surgeries.

Granted, it's far easier for consumers to go digital than it is for physicians, given the technology overhauls often involved. It took Grimstad an hour to type her medical history into her iHealthRecord account with San Francisco-based Medem Inc.

Details of her fibromyalgia, which causes chronic pain and fatigue, and Behcet's syndrome, an immune system disorder that causes ulcers and skins lesions, are password-protected and easily updated.

Before Grimstad left her Kent, Wash., home for a recent trip to California to help plan her daughter's wedding, she knew that if she had a health crisis her account could quickly bring a new doctor up to speed on her ailments. A wallet-sized emergency card has directions on accessing her iHealthRecord account.

``When you go to a new doctor, they always ask, `When did you have this and that and the other thing.' All of that's right there at their fingertips _ the dates, any medications you have, everything they need,'' she said.

The federal government, insurers and consumer advocates are putting growing pressure on the nation's hospitals and doctors to embrace electronic health records and related technologies.

Making the switch will eliminate paperwork costs and reduce the estimated 50,000 to 100,000 deaths each year from medical errors, which include medication foul-ups resulting from poor physician penmanship.

But doctors have been slow to join the digital revolution. A Rand Corp. study published this year found that in 2002 between 10 percent and 16.4 percent of the nation's physicians had adopted electronic medical record technology.

What's holding things back isn't simply doctors set in their ways, said David Brailer, the federal government's health-information technology coordinator. Brailer, who is pushing the federal government's goal of making sure most Americans have computerized medical records within 10 years, says the cost of new technology and retraining staff is too formidable for many small practices.

But it's not just cost. Differences in technical standards and features among the software made by more than 100 software vendors hamper doctors' ability to exchange patient data with other physicians and hospitals.

The federal government is trying to change that by encouraging private industry to settle on software standards and features so the data can be easily exchanged. Federal agencies are also mulling possible incentives, such as grants, loans or tax credits, to encourage doctors to go electronic.

But until industry standards are set and software prices come down, most of the small-doctor's offices that handle about three-quarters of the nation's health care needs will be hesitant to sign on, Brailer said.

``If small-doctors' offices aren't online, patients are going to miss big chunks of their data and it frankly won't be that useful to doctors,'' Brailer said. ``We want to have a world where the data follows the patient.''

When that day comes, patients who want a second opinion will have a much easier time arranging one, said David C. Kibbe, director of the American Academy of Family Physicians' center for health-information technology. Currently, getting a second opinion means collecting records from several physicians, radiology offices and labs.

Kibbe said a recent survey of the academy's 105,000 members found that more about 15 percent currently use electronic health records. Another 30 percent to 40 percent are ``looking very seriously'' at joining them in the next few years, he said.

WellPoint Inc., the nation's largest health benefits provider, last year enticed 25,000 of its high-volume physicians in California, Georgia, Missouri and Wisconsin with a choice of either free computers to submit claims electronically or PDAs for writing e-prescriptions that eliminate doctor's notoriously sloppy handwriting.

For a host of reasons, about a quarter of the physicians passed up the $42 million offer. Among the 19,600 who bit on it, only 2,700 chose the PDAs, Dell Axims that run on Microsoft software, said Carl Volpe, vice president of strategic initiatives for WellPoint's health solutions division.

Although the company had hoped more of the doctors would have chosen PDAs to help reduce medical errors, Volpe said WellPoint realizes that adopting new technology is a big step for any business.

``When you talk to physicians about new technology, the common discussion right now is how does the new technology fit into their existing work flow?'' he said. ``They want to know how their work flow will change.''

Dr. Jim Morrow, one of eight doctors and eight physician assistants with a three-office family practice in suburban Atlanta, said he and his colleagues switched to electronic health records in 1998 at a cost of $150,000 for computers and software.

For the first few weeks, things were a bit chaotic, he said, because it took longer to examine each patient while the staff adjusted to typing notes and prescriptions into computers, instead of scribbling things down.

But the change more than paid for itself in the first year, Morrow said, through $225,000 in savings that came largely from eliminating the costs of transcribing notes after patients' examinations and adding them to their growing paper files.

Going digital also increased the speed and size of insurance reimbursements, he said, because insurers now receive more detailed accounts of patients' progress and they get them more quickly with electronic submissions.

Morrow said he would never go back to paper files.

Among other things, he and his colleagues can keep closer track of his patients' treatment because the practice's system has prompts when it's time for patients to get annual tests such as mammograms or prostate exams. The practice's 59,000 patient files are also linked to a database that warns when a doctor writing prescriptions is prescribing a potentially dangerous drug combination.

``I'm a much better physician because of it,'' Morrow said.

While he's riding the new technology wave, his old medical school classmate, Dr. Ralph Riley, is sticking with paper records for now.

Riley works nine to 10 hours a day seeing more than 100 patients at his practice in rural Saluda, S.C., with the help of a nurse practitioner and physician's assistant.

He recognizes the benefits of electronic health records, but said the cost, lack of uniformity among software and the disruption of switching from paper to electronic records would be too daunting for him right now.

``Getting to electronic medical records is like going to paradise, but you have to walk through a bed of hot coals to get there. I want to get there _ I just don't want to get my feet burned on the way,'' he said.

Consumer advocates have their own worries.

Emily Stewart, an analyst for the nonprofit Health Privacy Project in Washington, D.C., said security and privacy issues posed by digital medical records have not been adequately addressed.

``Consumers are the biggest stakeholders here, and the success of any national health network will ultimately depend on their trust and participation,'' Stewart said.

Edward Fotsch, the chief executive of Medem Inc., said his company's fledgling iHealthRecord system protects patients' date with encrypted security features modeled after those adopted by the financial-services industry.

He believes Medem, a nonprofit founded in 1999 by the American Medical Association and six other medical societies, can help win over patients who will then encourage their doctors to make the switch from paper to digital records.

About 100,000 doctors who subscribe to Medem's Web site and doctor-patient e-mail services are now linked to its iHealthRecord service, he said.

Aside from tying their records into one online package, participating patients are kept abreast of the latest medical research and are quickly notified by e-mail when the U.S. Food and Drug Administration pulls a drug they are prescribed.

``It's a personal health record but it's really interactive. It reaches out to you and tells you things you need to know,'' Fotsch said.
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