Generations of children have walked into the doctor’s office to be greeted by a white-coated physician with a stethoscope and a folder in his hand. But the last detail, if a trend at Stanford Hospital and Lucille Packard Children’s Hospital is any indication, is about to change. Medical centers across the country, Stanford’s among them, are adopting electronic medical records (EMRs) in response to some pragmatic concerns and financial incentives from the federal government.
Dr. Scott Sutherland, clinical assistant professor of pediatrics at Lucille Packard, believes that EMRs are a positive addition to the medical profession.
“It used to be that blood pressures were charted on paper flow sheets, and it was easy to look at the past 24 hours’ worth of blood pressures,” he said. “Now, the flow sheet goes on forever, so I can look at the past seven days’ worth of blood pressures and [chart] those trends.”
With the capability to essentially “Google search” the information they need, doctors now have easy access to more data than ever when assessing the proper treatment for their patients.
In addition to UC-Los Angeles and Harvard University, Stanford is one of the leading universities to adopt EMR use in their facilities.
“In the past, patients would have volumes and volumes of paper records that were not very well organized,” Sutherland said. “Electronic medical records allow you to keep all the information in one spot.”
Along with Dr. Christopher Longhurst, Lucille Packard chief medical information officer, and Dr. Jennifer Frankovich, Lucille Packard pediatrics instructor, at Stanford Hospital, Sutherland recently used EMRs to determine the proper treatment for a girl who had a rare case of lupus, an autoimmune disorder. By using these digitized records, the team of physicians was able to statistically determine the best treatment for the girl rather than rely on anecdotal evidence from their own experiences and those of their colleagues.
“These EMR systems will allow us to do clinical research based on aggregated patient data,” Frankovich said.
Dr. David Blumenthal, the Obama Administration’s former national coordinator for health information technology and a physician at Massachusetts General Hospital, was one of the vanguards of EMR advocacy, and continues to promote the electronic records within the broader scope of American healthcare reform.
“Massachusetts General Hospital has been implementing an electronic health record since probably more than a decade ago,” Blumenthal said. The hospital “has a combination of systems that were self developed, and they were deployed in the early 2000s… when I first started using electronic health records.”
And the benefits of these records, according to Blumenthal, are many.
“At the simplest level it means that records are more easily accessible and not lost,” he said. “They’re available at the time the patient is seen and you don’t have to request for them in advance.”
And the advantages reach beyond expedient access, he argued.
“At a more complex and important level, the records are more complete and the data is easier to assemble,” he said. “It improves the completeness, quality and safety of care, and I think over time will save in expenses.”
However, Blumenthal admits that there are a series of challenges that come with adopting such records, even if the pros might eventually outweigh the cons.
“There is more data entry required because the chart is structured and therefore every physician doesn’t create his or her own template,” he said. “Information is more complete, therefore it is more time-consuming to digest… Physicians and other caretakers don’t have that problem to that extent when is the information is written.”
Since 2009, the Obama Administration has encouraged the use of EMRs in hospitals and doctors’ offices across the country. As part of the American Recovery and Reinvestment Act, a series of provisions entitled the High Tech Act set aside up to $29 billion dollars to prompt physicians and other professionals to adopt electronic records in lieu of traditional paper ones.
Hospitals and physicians “could receive the funding if they used so-called certified electronic health records in a meaningful way,” Blumenthal said. “That gives importance to the term meaningful use. Physicians can get extra money if they become users of electronic health records.”
Dr. David Feinberg of the UCLA Medical Center, like Blumenthal, argues that there are both advantages and disadvantages to using these types of records.
According to Feinberg, EMRs have not been pivotal in diagnosing a specific case at UCLA, however they are currently in the process of implementing EMRs throughout their four hospitals and 200-plus clinics in Southern California, which might bode more promising results. This process should be done in about a year.
EMRs “allow us to manage quality in a more robust way,” Feinberg wrote in an email to The Daily. They “allow us to become even an even greater learning organization.”
Ultimately, physicians like Sutherland, Feinberg and Blumenthal feel that EMRs will be more widely adopted over time, so long as they are used in a manner that supports their overarching goal.
“It won’t happen automatically; they must be used to their full capacity,” Blumenthal said. “They certainly have some potential to reduce spending in ways that would not be possible with paperwork.”
— By Stephanie Wang and Molly Vorwerck