For at least three decades, technology companies and physicians have worked to transform the health care industry with information technology: electronic medical records, billing and scheduling software and systems to interface with other practices and facilities.
The effort has been tremendous—but only partially successful. About 4 percent of doctors who see outpatients use a fully functional electronic medical record (EMR) system, and about 13 percent use a very basic system, according to a 2008 study published in the New England Journal of Medicine.
But soon, the American Recovery and Reinvestment Act of 2009 will pump about $19 billion into the medical information technology industry. The bulk of this money will be used as a carrot to entice doctors and hospitals into trying out EMRs, with reimbursements of $44,000 to $64,000 per physician.
The impact of this windfall will be immense, says Zubin Emsley, CEO of ChartLogic, a Salt Lake-based company that provides EMR and practice management software to physicians.
Emsley explains that about 85 percent of the nation’s doctors—those with no EMR system at all—now have a substantial financial incentive to invest in one. “It’s going to change our market completely,” he says. “We expect the demand for our product to increase by a factor of five.”
The unprecedented infusion of customers and cash will likely boost research and development efforts, leading to better EMR products. And the stimulus money comes with some strings attached that will also lead to better EMR systems. In order to receive the reimbursement, doctors must purchase EMR systems that can support “meaningful use.”
The definition of meaningful use, says Emsley, is rather vague. But at the very least, EMR systems should allow electronic prescribing, and be able to connect with other practices and hospitals so that information can be shared.
And of course, for medical facilities to have the ability to share information such as an emergency room in Florida quickly accessing your entire medical history in Utah, is one of the ultimate goals of the EMR industry.
“ChartLogic has already been moving in that direction,” says Emsley. “The stimulus money is going to push other companies to move in that direction
But money is not the only reason physicians have turned their backs on EMR systems. Common complaints are that the systems can be hard to learn, time consuming and disruptive in the examination room.
If these issues are not addressed, doctors may purchase systems using the stimulus incentive money, but
then end up shelving the new technology in frustration.
“It’s a little scary,” says Amy Rees Anderson, CEO of MediConnect, a Utah company that retrieves and transmits medical records for the insurance and legal industries. “Because of this stimulus money, we’re going to see 50 bazillion little EMR companies pop up. We’ll see a lot of startups that don’t have good support on training or installation. Doctors will make the attempt, but if it doesn’t go well, they’ll give up on EMRs.”
But excellent systems are on the market, says Dr. Kerry Stratford, a family practitioner in St. George. “I did a lot of looking around, and things seemed to come together about six years ago—the software and the hardware were finally advanced enough to work efficiently in a clinical setting.”
Dr. Stratford now takes a hand-held tablet computer into the examination room and is able to “write” his notes onto the tablet with a pen during consultations. “I used to write my notes on paper as I talked to patients,” he says. “I was able to directly translate what I was doing on paper to the tablet PC.”
He can not only take notes, but he can jump on the Internet to find other information, such as drug interactions, or he can print out informational pamphlets for patients. His system is also integrated with his scheduling and billing software, providing a comprehensive set of tools for the practice.
“I have a partner who doesn’t even type—and he uses the technology. It’s that easy,” says Dr. Stratford.
Essentially, the system has allowed Dr. Stratford to become a more effective physician. “I don’t have to worry so much about busy work, like copying medication lists. I can talk to the patients more—I have more time to sit and visit with them. I actually enjoy my practice a lot more than I did 20 years ago.”
In fact, instead of slowing him down, Dr. Statford says his EMR system has allowed him to see more patients each day.
ChartLogic also promises ease of use to its client physicians. “Our system uses voice recognition software so that whatever the doctor says is immediately converted into text and sent into the medical record,” explains Emsley.
ChartLogic was founded in 1994 and has, in essence, witnessed the infancy and development of the EMR industry. The key to ChartLogic’s success, says Emsley, is the fact that its system is so adaptable to the unique workflow of each individual practice.
Traditionally, doctors dictate their notes and send them to a transcriptionist, who types up the notes. Then the notes are returned to the physician’s office, where they are stored in an ever-growing set of file cabinets.
With a ChartLogic system, the doctor’s dictated notes are instantly stored in a patient’s electronic medical record—no paper, no folders, no storage room.
The software also responds to spoken commands, like “prescribe.” Doctors can also order lab tests or other procedures.
“We don’t know of a more convenient way to get information into the record and to get orders out,” says Emsley. “And it’s not that hard to learn.”
The software is more than a record-keeping system. ChartLogic also provides “practice management” software: a full suite of billing and scheduling software to streamline the administrative side of a practice. Additionally, the company offers interactive patient education features like videos and pamphlets.
Talk to Me
Hundreds, if not thousands, of companies offer EMR systems to doctors and hospitals. But it’s not just about storing records electronically anymore. The Holy Grail of the industry is the ability to quickly and efficiently share information among physicians, clinics and hospitals.
Unfortunately, many of the existing systems were developed in isolation and are unable to talk to each other.
“The characteristics of what physicians are going to buy are changing,” says Emsley. “In the past, having information accessible outside of the practice was not an issue.”
Since 1993, the Utah Health Information Network (UHIN) has been working to facilitate the transfer of medical information. UHIN, a non-profit organization, operates an electronic data exchange network—essentially serving as an electronic post office between doctors and medical facilities in Utah.
The organization is in the process of launching a new Clinical Health Information Exchange (cHIE), which will enable doctors—with their patient’s permission—to view that patient’s clinical results from many different providers or medical facilities. cHIE hopes to link many of the EMR vendors into the system, so doctors can use the tools they are familiar with to access patient records scattered among many providers.
“Using cHIE and with my permission, my doctor can query databases around the state and get my information in real time,” explains Jan Root, executive director of UHIN. Any physician could quickly find out what medications you take, what you are allergic to, and what tests and procedures you’ve already had.
UHIN and cHIE rely on national standards for data coding to store and transmit medical information. One day, perhaps systems like UHIN will be able to connect on a national level.
Root compares the $19 billion in stimulus money for EMR adoption to the post-WWI effort to build a national highway system.
“Our country needs to invest in our six-lane highways that make the exchange of information rapid, safe and appropriate,” she says.
The Future’s So Bright
For MediConnect, retrieving medical records often means scanning paper documents to create a digital image that can be transmitted around the world.
“You can image it—you can digitize it—but it’s like a snapshot. It’s still just information on a page. It’s not useable data until we go in and mine that data out,” says Anderson.
MediConnect teases out and codes the significant words in paper records—the diagnoses, the procedures and the treatments, among other things. “We will actually extract the elements of information and put them into a database,” says Anderson. “So what we do is make an EMR after the fact.”
The company is anxious for the day when the majority of doctors have EMRs and retrieving a record is as simple as clicking the mouse.
But there are significant implications to having this kind of medical information stored in databases. In fact, the U.S. Department of Health and Human Services is hoping to be able to mine these kinds of databases to determine, on a large scale, what treatments prove the most effective.
In essence, the department should be able to refine a set of best practices for the treatment of various conditions.
“There is so much you can do with data once you have it. There’s so much predictive modeling that can be done on patients when you have really good data,” says Anderson.
The most exciting result from the push for EMRs may be for patients—with greater access to their own records.
According to Anderson, MediConnect was approached by Google Health and Microsoft HealthVault to integrate the backend of their consumer health portals, which allow individuals to collect all of their health information in one place online.
“Patients began coming directly to us because there are limitations with Google Health—they could only see the data, not the actual imaged records,” says Anderson. “So now we are in the process of launching a direct consumer portal that will include the digitized images of their original records.”
Once MediConnect’s portal is launched, patients will be able to see lists of all the medications they’ve been prescribed, all the procedures they’ve had, and explanations for much of the medical terminology—as well as images of their physician’s handwritten records.
However, while this may be exciting for some patients, it raises privacy concerns for some who don’t like the idea of their private medical information in cyberspace.
But as UHIN’s Root explains, some consumers have become very comfortable with sensitive data being stored on the Web. Internet banking is one example of how consumers already store sensitive data online.
“Patients would end up with more control over their health information than they have now,” Root says. “[UHIN] is trying to build a system that does not allow inappropriate access. We want to err on the side of less access.”
Dr. Stratford agrees that EMRs will ultimately empower patients themselves. “In the future, there will be greater collaboration between physicians and greater collaboration with patients.”