Dr. Julia Rosenstock begins her workday like many Americans: She checks her computer, the lifeblood of her daily routine.
But where others peruse emails or monitor their portfolios, Rosenstock studies nurses’ notes and checks her patients’ vitals.
If someone’s condition has deteriorated overnight, she’ll scurry off to see them, stat. Otherwise, the 35-year-old pediatrician will begin her rounds at Mt. Washington Pediatric Hospital.
After evaluating each patient, she’ll type her orders for procedures and prescriptions into the computer by every bedside, sending the information to the right department in real time. When nurses stop by to fulfill those orders, they’ll first scan the barcode printed on each patient’s wristband for clearance to administer the drug or test.
Mt. Washington Pediatric, along with a rapidly growing number of other health care providers, uses Electronic Health Records (EHRs), a computerized system that replaces the stacks of manila folders containing patients’ medical records.
EHRs are the cornerstone of the health IT industry, enabling clinicians to share and access patient information with greater efficiency and accuracy. Providers say they reduce errors, help prevent repeat testing and improve patient outcomes. Plus, Rosenstock said, it keeps clinicians organized and calm — a worthwhile goal.
“It’s the first and last thing I use every day…,” she said. “I can’t imagine how a hospital could continue to be viable without Electronic Health Records. I can’t imagine how they would recruit new doctors. I mean, can you think of a job where they would say, ‘Yeah, we don’t work on computers here’?”
Some hospitals around the state, and more around the country, still rely on paper notes, but they’re in the minority. Health IT has infiltrated doctors’ offices and hospitals across the country, and by some measures, Maryland is at the front of the pack.
Adoption rates are soaring, partly due to technological advances and partly to strong, coordinated efforts by federal and state governments to promote the use of health IT, which includes everything from telemedicine to online prescription ordering to filmless radiology.
Overall, Maryland hospitals have higher IT adoption rates than the national average, according to a June 2012 report by the Maryland Health Care Commission. By the end of 2011, 41 of Maryland’s 46 acute-care hospitals had implemented electronic medical records. (A commission spokeswoman said that’s the most recent total available, but more hospitals may have switched during the past year and a half).
Some hospitals that use EHRs — including Mt. Washington Pediatric, which began implementation in 1996 — aren’t counted in that total because they aren’t considered “acute” — they don’t have emergency rooms or other critical-care departments.
A changing tide
The convergence of information technology and health care began in the 1990s, thanks to advances in computer power, high-speed networking and similar developments.
At first, health professionals used IT primarily to streamline operational functions, like billing. Only in the past five to 10 years, with the introduction of applications and devices used throughout care delivery, has IT permeated the clinical side.
“The clinical piece is really what’s been lagging,” said Henry Franey, chief financial officer for the University of Maryland Medical System — which has a database of 3.5 million patients and uses 2,100 servers to support 900 clinical applications. “Catching up to the times and getting more sophisticated is what’s tough.”
Electronic records definitely boost the “sophistication” factor, providers say.
“The old system was to write an order on a certain chart, and there’s a little wheel you turn to a certain color to indicate the urgency,” Rosenstock said. “Then you try to pass the message along to the nurse, but paper is difficult because you want to make sure they get the memo if something important has to be changed, but you have to physically go track them down. But maybe you can’t find them, and you’ve got to get back to your patients, so you run around worrying …”
“But if I put it in the computer,” she continued, “I know the nurse sees it, because we’re all putting our own data in there. We check it constantly. So it means I’m not spending time trying to physically hunt people down, or wondering whether the pharmacy got the order I sent.”
That process, known as computerized physician order entry, is usually a component of an EHR. By 2011, about 83 percent of Maryland hospitals were using CPOE — a 28 percent increase from 2008 and about 60 percent higher than the national average, according to the MHCC report dated June 2012.
Maryland is also ahead with adoption of barcode medication administration software. Nationally, about 27 percent of providers used it in 2011, compared to almost 70 percent in Maryland, according to the MHCC report.
That’s particularly useful at Mt. Washington because of its unique patient population, Rosenstock said. Most patients transfer from an acute hospital, most have complex medical issues — and many are newborns.
“For parents, of course their infants are unique,” Rosenstock said. “But if you have a bunch of small infants, well, they can look very similar, and you would never want to mix them up. And it absolutely could happen.”
Sharing data among clinical departments is just the beginning. Now, many clinicians can share data with doctors working in completely different medical systems via statewide Health Information Exchanges (HIEs) — a priority of the federal government.
Maryland was the first state to connect all of its acute-care hospitals to its HIE, the Chesapeake Regional Information System for our Patients (CRISP), which went live in 2010 and now receives admission, discharge and transfer information from at least 48 hospitals. The goal is for all Maryland providers to be able to share many more kinds of data.
Officials say by aggregating information stored in separate records, the exchanges will help doctors make better-informed decisions based on a patient’s comprehensive medical history. The ultimate goal is to cut costs by enabling providers to work more efficiently.
CRISP received almost $16 million in federal stimulus funds, plus a $10 million state grant, to support its roll-out and early outreach activities. It’s somewhat ambiguous where CRISP’s future funding will come from, and how much money it might save providers. According to CRISP’s website, “long-term funding needs and sources are not set, but CRISP is expected to create cost-savings and value to providers that at least will cover ongoing expenses.”
State officials are in the process of passing regulations to deal with privacy concerns associated with sharing so much patient information via CRISP. Officials point out, though, that the exchange is not a centralized patient database; it’s just a secure way to send records back and forth at the time they’re needed, replacing less reliable communication methods, like faxing handwritten notes.
Rosenstock said she’s looking forward to that capability.
“Many, many different people will have cared for a patient before that person comes to us,” she said. “And sometimes what we want to find out isn’t as simple as a test result. It might be more of a judgment call about how a certain treatment was received. Those detailed notes wouldn’t be so easy to gather by making frantic phone calls to other hospitals, but they could be included in their electronic medical record.”
Beyond the records
Electronic records receive the most attention, but a variety of tools fall under the health IT umbrella. Many providers are implementing technologies geared toward improving the patient experience. They’re often cheaper, easier to install and can deliver quicker cost-savings.
Katzen Eye Group has revamped several daily activities, and CEO Dr. Richard Edlow said the changes have delivered measurable efficiencies and cost-savings.
For example, it used to cost Katzen $1.04 to confirm one patient appointment.
With about 8,000 appointments per month, the employee labor hours and telephone minutes added up, said Edlow said. Now, thanks to recently installed software that confirms appointments via text or email, confirmations now cost 9 cents apiece.
Edlow said the practice, which has four Maryland locations, has spent about $100,000 over the past several years on a handful of similar technologies under the umbrella of “health IT.”
“We’ve already recouped a lot of that,” Edlow said. “We’ll still be recouping some of it over time, but we’re very confident that these technologies will turn out to be great investments.”
His confidence isn’t shared by many other providers, who are also investing in IT but don’t have the cost-savings to show for it.
Most providers don’t expect to recoup their investments any time soon, however.
For an analysis of the complex financial challenges of implementing these technologies, see The Health IT evolution: For providers, high cost and high priority.
Click here to read: The health IT evolution: Data analytics and the private sector’s role.