Doctors, patients get new ways to share information as records go electronic

As vice president of technology operations for Southwest Medical Associates, Tammy Jongeward knows how computer technology is transforming health care. But, from a personal perspective, she probably understands it better than most.

She jokes that she has been a "frequent flier" when it comes to medical care. Last year she had a heart-valve replacement, so at one point was on 21 medications and had a calendar full of appointments with the cadre of specialists overseeing her care.

Just a few years earlier, her daughter was born premature, which meant Jongeward had to keep track of a dizzying amount of medical information day after day: lab work, diagnostic tests, medications, a continual stream of consults with doctors.

Yet, in both cases, what helped give Jongeward some peace of mind was, of all things, her computer.

Through what's called a secure "patient portal" on the Southwest Medical Associates website she was able to access electronic health records that helped her manage the barrage of information. She could print out the names of medications she was taking during her illness, for example, and hand it to the doctors who were trying to direct her care. She could have lab results at her fingertips, request prescription renewals or coordinate her daughter's appointments.

"That was just huge for me, because you're already going through that emotional trauma or stress," she said.

Jongeward's story reflects exactly the kind of patient empowerment, the kind of free flow and transparency of medical information, that the government wants as it pushes the nation's medical community toward adopting electronic health records.

In 2009, as part of the American Recovery and Reinvestment Act and the continuation of a policy in favor of the national adoption of electronic health records during the President George W. Bush administration, billions of dollars were allotted for the promotion of electronic records.

The government hopes to have physicians online with electronic health records by 2015 by offering financial incentives, while also penalizing those who do not meet the deadline by reducing Medicare payments.

The idea, the legislation says, is that each provider meet "meaningful use" standards through their electronic health records that will result in a medical system that provides more accurate, accessible patient information, improves the quality of care and lowers the ever-rising costs of a system bogged down in paperwork and inefficiency.

In 2006, about 20 percent of Nevada's physicians used some form of electronic health records and it would be "on the high side" to say that we are even halfway there now, said Lynn O'Mara, Nevada's health information technology coordinator.

signs of change

Patients have seen changes and more are coming as the government's deadline approaches. Locally, hospitals and larger physician groups with the money and information technology staff already have turned toward electronic health records in some form.

Comprehensive Cancer Centers of Nevada, for example, started using electronic records a decade ago to streamline radiation-treatment planning. By 2009, the majority of the practice had adopted electronic health records and now uses a proprietary module called iKnowMed, a "robust" program that includes profiles of patients' histories, and information on individual treatment plans and lab studies, said Dr. James Sanchez, a private practitioner at the Comprehensive Cancer Centers of Nevada who also serves as its president.

Comprehensive Cancer Centers of Nevada has also integrated with LabCorp and Quest Diagnostics, which can transmit data directly into the cancer centers' system. In the future, the cancer centers will develop a portal that will let patients access their own records, he said.

Sanchez noted that going electronic has also meant taking patient care a step further by giving physicians access to patient information just about anywhere.

"If I'm rounding at the hospital and one of my patients has been admitted and I need the most updated information from their clinic chart, I can just go on a wireless device, whether it be my smartphone or an iPad, and click onto their clinic chart and obtain the information. If I'm working at home and I didn't finish my charting, I can simply go home and complete my charting at home," he said.

HealthCare Partners Nevada began piloting an electronic health records program in 2009, but its adoption was already planned before the government push toward electronic records, said Philip Fegan, vice president of information systems.

The growing practice - which had 16 clinics in 2009 and now has 50 across Southern Nevada, including Pahrump and Boulder City - will eventually be completely wired, with all of its primary care physicians, specialists and urgent cares having access to patient data.

"That physician will instantly know everything about them," Fegan said. "And it's a huge benefit for coordinating patient care and safety because that doctor's going to know your allergies, what medications you're on, even if they're only seeing you for a sprained ankle or something."

HealthCare Partners is also creating its own computer application that will let patients access their health information from mobile devices, and is working with its electronic health records vendor, Allscripts, on an iPad application for physicians so they can view health records on devices even less intrusive than their laptops.

Fegan said the idea has always been to stay away from the clunky exam-room computers "bolted to the wall" that were used to access electronic health records in the past and enable physicians to sit with patients face to face.

"We wanted something they could put down beside them, the same way they would a paper chart. … That is the most important part of the visit, the face-to-face interaction. We can't get in the way of that," he said.

GOALS FOR HOSPITALS

For hospitals, the goals are the same - accuracy of information, efficiency, better care. But they face the challenge of patients who are often suffering from a multitude of medical issues, which can mean different specialists overseeing their treatment, a host of medications, and revolving teams of staff overseeing 24-hour care.

St. Rose Dominican Hospitals, the only nonprofit hospital system in Southern Nevada, announced in November that its electronic records are now fully integrated so that patient information, including doctors' notes, medications and test results, can be accessed by any of the St. Rose facilities, said Dr. Allen Marino, chief medical officer and sponsor of the hospital system's electronic health records project.

In the coming year, St. Rose Dominican Hospitals' electronic health records program will be broadened. Starting this month, the hospitals will use a technology that lets staff cross-check medications and will let patients scan a bar code on their identification bracelets to see lab test results.

There are also plans to implement an electronic documenting system called PowerNote, and an electronic module called PowerPlan that helps physicians manage patient care, Marino said.

The system, Marino said, should improve the clarity of information, prevent redundancies in testing and charting, decrease medication errors and reduce patients' length of stay.

"I do think if we did this five years ago we would have been probably met (by the staff) with a, 'Oh some new-fangled thing you guys are trying to throw at us,' " he said, "but I think everybody in health care gets it, and understands and appreciates that this does drive patient safety."

As electronic health records evolve, the idea is that they will enable physicians and patients to work closer together.

Physicians, for example, can now sit with patients and show them trends in their health status via computer, such as blood-pressure readings that could be dangerous, or how losing weight has helped lower their bad cholesterol. Some medical organizations are taking this idea further by fine-tuning their electronic health records systems or contracting with vendors who are already on the path of patient-focused technology.

Southwest Medical Associates, which started going electronic as far back as 2000 and now has more than 235 physicians using its electronic health records, is now ready to concentrate on using its patient data to provide "population management," Jongeward said. In other words, reaching out to patients through text messages or email.

"What we're looking at is how do we manage and make sure we capture everyone, not just wait until they show up but that we're now outreaching to these patients to say, 'We need to make sure that you have the care that you need - you're missing this, you're missing that, you need to have your colonoscopy at 'x' age, you haven't had your mammogram.' " she said.

A USEFUL EXCHANGE

The future is also bringing health information exchanges that will adapt the technology so different medical organizations, with patients' permission, will be able to share secure patient information. An emergency room physician, for example, will be able to pull up records from a patient's primary care physician.

The state is receiving about
$6.1 million in federal funds to create a health information exchange that will, among other things, eventually allow Nevada to share electronic health information across state lines, O'Mara said.

Locally, a health information exchange was launched in July 2011 by HealtHIE Nevada, a nonprofit corporation developed by a consortium of local hospitals and medical groups such as University Medical Center, Valley Health System and Steinberg Diagnostics, that are already sharing data electronically.

All of this does not come without its problems. Security of information is still a concern for patients and physicians, particularly in these beginning stages. Also, there is the high cost and training hours involved in adopting an electronic health records system.

Sanchez noted that going to electronic records has probably added at least an hour to the cancer centers physicians' daily workloads. And he points out that when you have constant access to patient data via smartphones or home computers, "you never leave the office."

Nevertheless, he would not go back to the days of the paper trail.

"I'm convinced that it makes me a better doctor. Now when it first started out I could tell you that my partners … were not convinced about that, but most of the physicians have settled down quite a bit, they really feel comfortable with it. There's a few that still have complaints but I don't think any of us would go back to the old days."