RX: IT
Information technology is slow to advance in the exam room
By Julie Jette The Patriot Ledger
Saturday, June 7, 2003

Cohasset -- When Dr. James Mitterando writes a prescription, there’s no prescription pad, no post-card-sized slip for a patient to pass to the pharmacist. Just a signal passing from his personal digital assistant, or PDA, though a server in his office and read by his computer.

Mitterando and the four other doctors and six nurse practitioners in his practice are participating in a pilot program sponsored by Blue Cross and Blue Shield to get doctors to switch from handwritten prescriptions to electronically submitted prescriptions using PDAs.

But Mitterando is in the minority. In a profession where the latest lifesaving technologies are pioneered and embraced, doctors’ examination rooms often lag behind their billing offices when it comes to information technology.

According to the Healthcare Information Management Systems Society, A national organization that promotes the use of information technology in medicine, only 5 percent of doctors’ offices in the country use a fully electronic medical record, the gold standard of healthcare automation.

Proponents of electronic medical records believe they can offer huge improvements in care, one day creating virtual medical chart that would give any provider in any location the ability to review an up-to-date patient history. They also believe they can offer savings in time, money and the avoidance of medical errors.

But getting there has been long and difficult.

“We’re still talking about getting a computerized patient record after 40 years,” said Dr. Lucien Leape of the Harvard School of Public Health, an expert in the study of medical errors.

Carla Smith, executive vice president of the Healthcare Information Management Systems Society, said the proliferation of handheld devices like the one Mitterando is using is a turning point in the electronic transformation of medical records. She said cost and immobility of previous computer devices were two major barriers to doctors’ use of information technology.

“It’s expensive to wire a physician practice in every single exam room with a desktop computer,” Smith said. “It’s relatively inexpensive to buy a PDA and then sync it to your main computer.”

With the costs falling and mobility of devices improving, Smith said, interest is growing. The American Academy of Family Physicians has set a goal of getting all of its 95,000 members to use electronic records by 2005.

Still, while many experts agree that infusing clinical practices with information technology will bring enormous benefits, such transformations are bring accomplished mostly in fits and starts.

“Health care is masterfully under-invested in information technology,” Harvard’s Leape said. “The investment per year on average over several decades has been almost an order of magnitude less than other industries.”

Dr. Thomas E. Sullivan, president of the Massachusetts Medical Society, is a longtime advocate of updated technology in doctors’ offices and hospitals. But he said he could understand why practices have been slow to adapt.

“Information technology basically really inserts itself within your daily work flow in a way which, it it’s not well designed, will slow you down and potentially cause you to make error,” he said. “To the extent that it makes us less efficient, it’s going to be a long sell before we adopt it.”

Smith, of the Healthcare Information Management Systems Society, said that as much as technology had advanced to transform offices and most industries, it is only now reaching the level of sophistication and ease of use that will make it a compelling buy for doctors.

Mitterando, who writes a health care column for The Patriot Ledger, describes himself as an “early adapter,” who likes sampling new technology. Since 1999, his office has been using voice recognition software for notes rather than a human transcriber.

Of his new PDA, he says, “We like it a lot. I think it provides for improved medical care.”

“The pharmacists love it because it provides clear, legible prescriptions. The patients love it because they don’t have to drop the prescription off at the pharmacy,” he said.

Using the PDA, Mitterando can get information about drugs his patient is taking. It instantly alerts him to possible bad interactions, as well as whether a drug is preferred by a patient’s health plan and carries a lower co-payment.

Mitterando said he has been challenged by some of the technology his practice has implemented.

The voice recognition system he uses, for example, required him to speak more slowly than he would if a person were transcribing his recorded notes.

“You have to talk slowly, you have to train it, you have to teach it any particular nuances you like to have in your note,” he said.

Still, his office uses the software because it saves the cost of hiring some to transcribe.

“It can save us thousands of dollars a year, so it’s a trade-off,” he said.

Demonstrating the financial return on IT investments is key to getting doctors’ practices to make them, experts said.

Pat Wise, director of the electronic health record initiative for the the Healthcare Information Management Systems Society, said the cost of a full-scale electronic medical record be anywhere from $10,000 to $200,000. Variables include the size of a practice, the amount of hardware and software the practice already owns the sophistication of the system.

However, she said, the American Academy of Family Physicians is trying to develop a system that would cost members $125 to $150 a month.

The Information Management Society gives two awards annually to hospitals that have successfully implemented electronic medical records. One recent winner, Maimonides Medical Center in Brooklyn has seen financial returns well beyond its projections.

The hospital, which is in an area with a large community of Hasidic Jews, serves a population of women who bear an average of eight children each.

Based on the hospital’s record in successful births and the electronic medical record it implemented in 2001, its high-risk obstetrics malpractice insurance premium dropped $2.5 million this year, Wise said.

“Where have you heard of any malpractice premium dropping?” Wise said.

Wise said doctors’ practices that have switched to electronic medical records are seeing economic benefits more quickly than they anticipated.

“Every small practice I’ve spoken to who had electronic medical records have all been unanimous that they have had a 100 percent return on their investment,” he said.

Mitterando said he is looking forward to the day when electronic prescribing is just one small part of a fully automated medical record in his office.

He said improvements in technology, like his PDA and new computer tablets that allow users to write on a full-size screen, will help. So will initiatives that bring down costs.

“Most physicians’ offices are small businesses, and they can’t afford the tens or hundreds of thousands of dollars to implement these systems,” he said.