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Medical Community Overcoming Reluctance To Track Patient Records On Computers

Over the last 30 years, computers have been absorbed into most walks of life.

But some hospitals and doctors’ clinics have avoided using the technology to keep track of patients’ medical records.

Now, using both financial carrots and sticks, the federal government is getting them to make their records electronic — so patients can see their charts and even take them to another doctor.  

Dr. Tom Yackel is the chief health information officer at Oregon Health and Science University. He has been helping the teaching hospital incorporate electronic medical records since 2008. But he admits that the health care industry as a whole has been slow to make the change.

“If we compare ourselves to banking or insurance, they may spend two, three, four times as much as health care on information,” Yackel says.

But now, after three years of generating data, he says he’s mining those records to save money and improve the performance of OHSU doctors.

“How well are their patients being immunized against influenza and pneumonia? How many of their patients have had their their mamograms, pap-smears, their preventive care screening? What percentage of patients have X-rays or images of their back that’s not considered appropriate for low-back pain treatments. We’re just starting to gather that data and figure out how we use it to change practice,” Yackel says.

He says patients can also log on to their computers to see their charts, check their lab results or schedule mammograms — all of which stands in stark contrast to 10 years ago, when he remembers wasting a significant slice of the day just trying to find each patient’s chart.

Across town, Dr. Brett White oversees the Gabriel Park Family Health Center in suburban Portland.

The clinic put computers in consulting rooms about three years ago. White says the effect was immediate. The machines started highlighting patients who’d been diagnosed with chronic diseases like diabetes, but who hadn’t been seen for a couple of years.

“And it was really, ‘Oh my goodness. We really need to reach out to that patient and make contact and bring them in to provide the care that they need,’” White says.

Some of the patients, he says, had taken their doctor’s advice and were fine. But not all.

“There were other individuals who, unfortunately, had sustained some pretty significant medical complications,” White says.

Now, the health center’s computers track those patients and make sure they get their cholesterol and blood sugar levels checked on a regular basis, White says. That way, patients who need it can get preventive treatment that will keep them healthy. So the system has likely saved those patients a lot of pain and a lot of money, according to White. 

But the computers don’t just look at what patients need. 

Sitting in a room with his colleagues, Dr. Scott Fields explains that computers are also being used to grade physicians on their performance.

“And my score card, he gets to look at, and I get to look at his. And my nurse gets to look at mine et cetera, et cetera. We all get to look at each others’,” Fields says.

Fields says doctors tend to be competitive.  And at first, he found the grading was difficult.

White cringes when he recalls his grade for getting women to take their regular mammograms.

“I think we’re biased a bit as clinicians where we think we have a really fantastic relationship with our patients on a one-to-one basis, when we’re seeing them in the room,” White says. “But to … see that there are areas, and in some cases significant areas of deficiency, it was a little disheartening.”

But White says that in his clinic, once most doctors saw how grading could help them improve, they were won over.

So, if electronic medical records are good for patients, good for doctors and good for the bottom line, why have they taken so long to be adopted?

Yackel says the reason is that preventive medicine saves money for patients and places like the Veterans Administration and Kaiser Permanente. But if fewer people turn up at hospitals and clinics because they’re getting preventive care, there may be a downside for those providers.

“It has to do with who gets the benefits. When the VA is able to do that, when Kaiser is able to do that, they lower their costs, because they are an insurance company. When a hospital that runs on fee-for-service medicine — they get paid for what they do — they get paid less,” Yackel says.

When Congress was debating changes to the health care system, the American Hospital Association argued that electronic medical records raise privacy issues.

In 2008, the association also said in a letter to a Congressional committee that spending money to computerize records might take resources away from patient care.

Back at Gabriel Park Family Health Center, White believes electronic medical records are good for the patient, the doctor and the bottom line. But, he cautions, electronic records are not the silver bullet that will slay all the nation’s health care problems.

“It’s challenging to interface with a computer when you’re in a room with a patient. But also spending a lot of time outside of the room typing. So, I don’t think we’ve hit sort of the ideal just yet,” White says.

So far, the federal government is not forcing hospitals and doctors to go electronic. What it’s doing is offering financial incentives to change. But some health care officials say they expect that some day, the government might cut payments to providers who fail to jump on board.

Our story on “computerized medical records” is one of a series of reports by Kristian Foden-Vencil on health care produced as part of a special project by NPR, its member stations and Kaiser Health News.

Kaiser Health News is a nonprofit news service covering health policy and politics. It is an editorially-independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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