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High-tech health care

Doctors go digital for a paperless future

David Campbell, Staff Writer
   Digitized health care is the wave of the future — no more paper files, messy doctor’s handwriting and misplaced lab results.
   But can technology cure all? Some health-care professionals and industry specialists say not necessarily.
   Dr. Gabriela Bowers and Dr. Brian Thomas are at the forefront of this burgeoning trend toward all-digital record keeping.
   In November, they opened a new medical practice, Windsor Regional Medical Associates, LLC in the East Windsor Medical Commons on Princeton-Hightstown Road in East Windsor Township. Because their practice is relatively new — it now has more than 300 patients and is growing every day, Dr. Bowers said — it doesn’t have to convert from cumbersome pre-existing hardcopy files to electronic charting.
   She and Dr. Thomas were completely digital the moment they opened for business. Absent are the filing cabinets one typically sees at a doctor’s reception desk. Instead, the two physicians each carry Tablet PCs — laptop computers with screens that can be written on — and which weigh a mere three pounds.
   "All our records are on computers," Dr. Bowers explained. "There’s no paper, no physical chart that has to be pulled from a file. You can see all patient details without having to hunt for a chart."
   Digitized patient information has its benefits, the physician continued, foremost of which are patient safety and convenience. She said she can access information from home if a patient calls with a problem. In addition, electronic files are much more legible and tasks like writing electronic prescriptions help to reduce the potential for medication errors.
   Dr. Bowers said she foresees all medical providers going completely electronic eventually, but added, "At this point, because most doctors are still on a paper format, we’re not there yet."
   Stefanos Damianakis, president and CEO of Princeton-based software technology company Netrics, which specializes in products for database matching and retrieval, said the digital revolution in health care is under way. But he said that the shift from paper to digital carries with it unforeseen challenges — which he said Netrics is helping to address.
   "How do you bridge the gap between the human tendency to be inexact and computers being strict and unforgiving?" Mr. Damianakis asked. "Most database solutions will not find a medical record unless you get it exactly correct. You need a more error-tolerant system, one that works more on human terms."
   He said a misspelling of a name can make data retrieval difficult, and can lead to another challenge for digitized health care: duplicate records, started because an existing one cannot be found. This, in turn, can lead to patient safety issues.
   "One file has me allergic to penicillin and the other doesn’t," Mr. Damianakis said.
   According to Steve Locke, director of technical services at University Medical Center at Princeton, about 90 percent of paper records at the hospital are available electronically, but that the official record is still paper. He said one of the sources of delay is human.
   While many physicians welcome the digital revolution, he said, some are used to hardcopy files and are somewhat resistant. Another factor is compatibility of data systems across the board, which probably won’t happen until the government steps in and mandates a health-care standard — free enterprise gets in the way, he said.
   Ron Czajkowski, spokesman for West Windsor Township-based New Jersey Hospital Association, said medical centers throughout the state are still awaiting guidelines on electronic record-keeping from the state Department of Health and Senior Services, but have begun converting from paper to electronic nevertheless.
   Mr. Czajkowski said NJHA has been "banging the drum" for change for some time now, but claimed the state is dragging its heels.
   At any one of the 120 hospitals in the state on average, he continued, the conversion from paper to digital records is about 80 percent complete. And yet, until the state makes a decision and formally allows hospitals to do away with paper altogether, Mr. Czajkowski said, hospitals are forced to keep both paper and electronic files, a duplication of effort that he said is financially and operationally inefficient.
   "We’re ramping up in anticipation of all hospital patient information storage to be electronic, but we need the state’s OK to cut away from paper," the NJHA spokesman said.
   Nevertheless, given benefits from digital storage such as ease of transfer of information and the elimination of physical files that can be mountains thick for some patients, he said electronic formats inevitably will become the standard.
   "Hospitals are making the investments, they’ve moved into the 21st century," Mr. Czajkowski said. "It’s the difference between a steam locomotive and a jet airplane — it’s something we have to do."
   Department of health spokeswoman Donna Leusner said the department is working with NJHA to meet the complex and fast-evolving changes in technology, noting that the state law governing patient records dates well before the digital age.
   The law was passed in 1920 and requires institutions to keep a record of patient treatments and "personal and statistical particulars." It does not specify the format, but needless to say it was paper back in 1920.
   Ms. Leusner said the state, the federal government and organizations like NJHA all have their sights set on the same goal of digitized formats.
   "We’re pleased that the federal government has made developing the infrastructure for a uniform approach to electronic medical records a priority, but we realize the country is years away from reaching this goal," she said. "We have gotten informal feedback from NJHA on an approach to some general guidelines and the department is continuing to refine its thinking.
   "We are not advising facilities that they must have paper as well as an electronic medical record, nor are we citing facilities that have chosen to store historical records in electronic formats," Ms. Leusner continued. "We share the view that electronic medical records offer tremendous promise."
   Dr. Bruce Siegel, program director of Washington, D.C.-based Urgent Matters, an initiative of the Robert Wood Johnson Foundation to help hospitals eliminate emergency department crowding, said digital is not a cure all — the human element remains a critical component to efficient delivery of health-care services.
   "Surely if you bring certain systems into the ER of the hospital it can help with issues of overcrowding and patient tracking, but in and of itself it’s not a panacea," Dr. Siegel explained. "We found some hospitals that had made huge investments in electronic medical records and other systems, but were still having problems with patient overcrowding and patient flow."
   Sometimes, the solutions that really work prove far less high-tech than one might think. For example, Dr. Siegel said, a hospital in San Antonio found that by simply moving hypodermic syringes from the hospital pharmacy directly to the emergency department, the medical center was able to reduce patient bottlenecks and inter-department red tape.
   "There is something of a misperception in the industry that electronic systems will stop all their problems," he said. "Certainly they can help, but you also have to address a lot of difficult organizational issues."
   Health-care industry consultant Dr. Charles Denham, who is a member of the Institute for Healthcare Improvement, another RWJF nonprofit initiative that is widely recognized as a driving force in quality-of-care innovations nationwide, agreed that technology isn’t the sole answer, but it can be an enabler of best and better practices.
   In the same way that employees changed the way they worked with the introduction of new technologies like e-mail, Dr. Denham said, new methodologies are needed to accommodate digital health care, and this isn’t always easy.
   "We’re moving to a patient-centered format, where the right information about the right patient at the right time for the right decision makers will become available at the point of care," he said. "And so that means a major paradigm shift about how we work together as teams and share information."
   Dr. Denham concurred that health-care providers are headed in the direction of completely digitized systems, but said that a unified standard is needed.
   "Right now we’re seeing vendors pushing their own proprietary standards to have an offensive and defensive share in the market," the industry consultant said. "This is beneficial to their short-term growth, but detrimental to the long-term adoption of their products in the market."
   The digital transformation of health care, while inevitable, is hindered by such market competitiveness, but a federal government mandate that there be fully digital medical records by the end of the decade will help, he added.
   "Now there is market incentive," Dr. Denham said. "Health-care purchasers are dissatisfied with the lack of quality of care."
   Dr. Bowers of Windsor Regional Medical Associates estimated that there are now more than 100 different electronic-records products available for purchase by doctors, and said that different medical organizations have recommended different systems.
   But the federal government stepping in to require electronic record keeping and transactions for all patients down the road — electronic prescribing is the most imminent federal mandate expected on the horizon, she noted — it could give rise to a standard format for all doctors.
   Despite the challenges ahead, Dr. Bowers said it will be well worth the effort. "Does it make the job easier?" she said. "Oh, yes. Definitely."