Electronic health records can save lives, threaten privacy

When Elmhurst Clinic converted from paper to computerized records, patients embraced the change.

Some doctors, it turned out, were the ones who had to be dragged kicking and screaming into the future. They didn't want to be seen bumbling around with a new computer system while they should be concentrating on their patients.

Dr. Joseph Kaliski, who helped implement the new system, said some physicians remain resistant, but most have come around.

While doctors have mixed feelings, it's patients who both stand to benefit from electronic medical records and, some critics say, have the most to fear.

As part of the federal stimulus package, President Obama's administration has included up to $19 billion in incentives for medical providers to go digital. The goal is for every American to have an electronic health record by 2014.

Obama says the switch will save countless lives and billions of dollars by reducing medical errors and duplicate tests, and prompting doctors to do more preventive medicine and prescribe fewer expensive drugs.

As advanced as U.S. medicine may be, it has a long way to go in digitizing its data.

Less than 2 percent of U.S. hospitals have adopted fully functional electronic medical records, according to a new study in the New England Journal of Medicine.

Other studies suggest most hospitals have at least a basic system, but just 17 percent of doctors have gone electric.

Cost is the biggest obstacle. A hospital system can run from $2 million to $100 million. But expenses are coming down. Sam's Club last week announced a program to offer a comprehensive system for $25,000 for the first doctor and $10,000 for each additional provider.

Interoperability is another big hurdle. Many hospital departments have trouble communicating with each other, let alone with other hospitals.

Security is the other big concern. Patients' advocates warn that if companies, insurers and pharmaceutical companies continue to have easy access to records, it could intrude on patient privacy and make patients hide their conditions.

But electronic medical records can also save lives. Physicians can pull up someone's medical history instantly, anywhere in the world, to help treat those who fall ill on vacation or who are brought unconscious into a hospital.

Results before you're home

Tim Kunzendorf, a 52-year-old electrician who lives in Glen Ellyn, recently went to Elmhurst Memorial Hospital with high blood pressure, and doctors were able to pull up his medical history immediately and see his medications and allergies.

"It's much better," he said. "If Big Brother is watching, who cares, as long as you can get coverage and service."

With both a commercial and federal push behind the concept, electronic health records becoming more common.

Systems at NorthShore University HealthSystem, Northwestern, and Swedish Covenant hospitals make the Chicago area a leader in the field.

Elmhurst Clinic, with offices in Addison, Bloomingdale, and Wood Dale, is also ahead of the curve, having installed a network in 2005.

Last Thursday, the U.S. Department of Defense and Department of Veterans Affairs said it will create the first national electronic medical records system for the military.

At Elmhurst Clinic, it took several years to go fully paperless. Initially, only those doctors who wanted to make the change did so, but as more physicians saw that it worked, they got on the bandwagon.

Now, some doctors have laptops in which they can enter the patient's medical history, symptoms, diagnosis, treatment, etc.

Others take notes by hand and enter them after the examination, while others dictate their notes using voice recognition.

The software allows interoperability so doctors can pull up radiology reports and lab exams immediately, in some cases calling patients with results before they even get home.

The records are not accessible to patients, but the system lets patients make appointments and get prescription refills online, and has automatic check-in at the office. It also notifies them when they're due for a checkup, test or shots.

The system also helped the clinic expand its practice, recruit new doctors, speed up billing and increase monthly charges by more than $1 million, while converting 2,700 square feet from paper storage to office space.

The information is accessible at Elmhurst Memorial Hospital, and doctors can access the information at home and abroad.

Unlike paper records, Kaliski said, the electronic data has backup copies at different sites, and if anyone looks at the records without authorization, it leaves an electronic record.

It also simplifies research, letting doctors easily see whether all diabetic patients are meetings goals for blood sugar and cholesterol levels, for instance, and seeing which treatments work best.

Increasingly, other large local groups are using electronic health records, like DuPage Medical Group and Midwest Heart Specialists, which once used its system to send information for treatment of a patient who had a heart attack while on a business trip.

Human oversight

Some critics are saying, not so fast.

Sharona Hoffman, a professor of law and bioethics at Case Western Reserve University in Cleveland, warns that benefits of electronic medical records come with risks.

The federal government needs to set standards, she said, so all systems can communicate, and there should be federal approval for systems, just as there is for new drugs, to ensure they are accurate when they make diagnoses or recommend treatment.

An electronic bar code system to match medications with patients could prevent hospital overdoses like the one that almost killed actor Dennis Quaid's children, who received dangerously large doses of a blood thinner as newborns in 2007. Or the same bar code system could cause serious problems if there's a glitch.

"If we don't have quality control," Hoffman warned, "these systems can be quite dangerous."

Patient Privacy Rights, a nonprofit advocacy group, is more concerned about how the information will be used outside of the doctor's office.

Already, pharmacies keep records of every patient's prescription history, which can be sold to drug companies or insurers. Patients' names are removed, but the organization says enough information remains that some patients could be identified.

Such disclosures already lead some patients to withhold information or put off health care, Katz said.

David Garets, president of the Healthcare Information and Management Systems Society, agreed private medical information is already known to insurers and others, so it's a policy issue, not a technical one.

While the stimulus plan added some consumer protections, lobbyists and the public will fight to set regulations on security and privacy.

The debate will also determine what information patients can access about themselves. While patients have a legal right to their own medical records, doctors are leery of providing widespread online access, or revealing their notes, which may not be flattering.

"Now it's up to all of us," Katz said, "to hash out these details to set us up for success."

<p class="factboxheadblack">What patients should know</p> <p class="breakhead">Pros</p> <p class="News">Quicker results: Patients can get fast results of lab tests and body scans</p> <p class="News">Convenience: Patients can schedule appointments and get prescription refills online.</p> <p class="News">Portability: Doctors can look up a patient's medical history, allergies, medications etc. anywhere in the world, allowing better care if the patient gets sick or is unconscious away from home.</p> <p class="News">Oversight: Electronic bar coding of drugs could help prevent getting the wrong medication or dose.</p> <p class="breakhead">Cons</p> <p class="News">Privacy concerns: Medical details may be accessible to insurers, employers, drug companies, marketers, the government, hackers </p> <p class="News">Costs: Systems cost $2 million to $100 million for hospitals and tens of thousands of dollars for doctors.</p> <p class="News">Glitches: Systems are vulnerable to malfunctions, power outages, viruses and crashes.</p> <p class="News">Interoperability: Hospitals can have a hard time getting systems for different departments, hospitals, pharmacies to communicate.</p>