Portable medical information helps ER care

Handling patients in the emergency department can be a bit frustrating at times for physicians, especially since they are typically unfamiliar with patient medical histories.

Having access to recent EKG results could be the difference between a patient being admitted into the hospital or receiving care and going home without having to undergo an expensive, and sometimes dangerous, test.

"The second-leading reason people come into the emergency room is because of chest pains, and oftentimes those pains don't have anything to do with the heart,'' said Dr. Steven Evans, a practicing anesthesiologist and vice president of medical affairs for Health Plan of Nevada. "But unless the emergency room physician has the patient's medical history to help rule out a heart problem, we may have to order an unnecessary test.''

As a way to prevent unnecessary testing and medical errors, and to better prepare emergency room physicians to treat Nevadans insured under a United Healthcare plan, Evans developed a portable medical record designed for hospital or emergency room care.

The record, a disc the size of a credit card, is loaded into an Internet accessible computer. It essentially connects to a portal operated by Southwest Medical Associates' IT department that contains patients' medical records.

Southwest Medical Associates is a subsidiary of United Healthcare.

The physician group went paperless about two years ago, meaning physicians no longer use paper prescriptions or charts.

The general idea behind electronic medical records, which has been pushed by politicians and the health care community for about 10 years, is to create transparency in medicine, cut down on expenses and have real-time medical information available to consumers and physicians.

Still, despite the uptick behind electronic or portable medical records, some in the medical community and the public have raised concerns about privacy. Most of those concerns center around protecting against identity theft and keeping a patient's medical records out of the hands of government.

Evans' idea came directly from his own experience.

"I used to manage one of the local hospitals and I would continuously see patients coming in the emergency room and their wishes weren't known because they didn't have an advance directive with them," he said. "That's what got me thinking about portable medical records. I went to emergency room doctors and asked them, 'If you had access to an electronic medical record, what would be the five or six things you would want to see?'"

In response, some Las Vegas Valley emergency room physicians said they would like access to a patient's active medication and allergy list, any current medical problems, last hospital or emergency room discharge summary and the most recent electrocardiogram results.

The physicians also wanted to know whether a patient had an advance directive, Evans said, referring to the legal documents that allow a person to convey decisions ahead of time about end-of-life care.

Dr. Dale Carrison, an emergency room physician at University Medical Center, said he is excited about the idea of portable medical records.

"At any time I could have a 76-year-old patient come into the emergency room who is taking 10 or more prescription drugs, and, unless that person has them listed, they're not going to remember each one of them,'' Carrison said. "And I'm not trying to offend anyone, but not even a 35-year-old can remember all of the medications they are taking.''

Carrison said it is important for an emergency room physician to know correct medications in order to avoid prescribing a drug that may conflict with what's already being taken. The same could be said about medical tests, he said.

Southwest Medical Associates isn't the first to develop and utilize portable medical records in the United States. Providers, such as the Department of Veterans Affairs, also use them. But Carrison said Southwest Medical Associates' portable medical record is better because it offers information in "real time."

"If I have an EKG at a Southwest Medical Associates' cardiologist's office, I can walk to Summerlin Hospital in 15 minutes and that test will be available to the emergency room physician,'' Evans said. "That's what we mean by real time."

Southwest Medical Associates' patients already have access to a personal Web page. There, they can schedule, change or cancel primary care physician and pediatric doctor appointments; they can also view medical records, immunizations and test results.

Patients can also request prescription renewals from their physicians, manage and update their personal account information and e-mail their physicians.

Some insurance providers, such as Anthem Blue Cross and Blue Shield and Cigna also provide health records by way of personal Web pages.

President George W. Bush in 2004 asked that medical records be available electronically within 10 years. And under President Barack Obama's economic stimulus plan about $20 billion has been set aside to invest in electronic health records.

Referring specifically to the Obama stimulus bill, Evans said there is a requirement that basic medical record information be sent to the government if doctors want to receive the $20,000 to $60,000 each in the bill for utilizing electronic medical records.

The databases will, "at a minimum," include information on race and ethnicity, Evans said.

Evans said some of the hospitals Southwest Medical Associates are working with also expressed concerns about their computers contracting viruses by using the discs.

Because the discs are "once-writable" the hospital computers are safe from viruses, he said.

"This is as hacker-proof as going out and using a credit card online,'' he said. "Obviously nothing's perfect, but this is safer than a person walking around with their physical medical records in hand.''

Evans said he has met with all emergency departments that contract with United Healthcare's plans. Each of the hospitals has agreed to ask for and accept portable medical records.

The hospitals have also set aside at least one computer with Internet access to use the disc. So far, more than 2,200 of United Healthcare's members are using the portable medical records, said Peter O'Neil, a spokesman.

By March or April Southwest Medical Associates plans to update the portable medical records so that all medical test results are available to emergency room physicians.

Contact reporter Annette Wells at awells@reviewjournal.com or 702-383-0283.