A few years ago, Dr. Charles Frazier was out of town when he checked his patient's electronic medical charts and spotted what appeared to be a brain tumor on the patient's MRI.
Frazier called the patient and referred him electronically to a neurosurgeon.
That was Thursday. As Frazier walked into a meeting on Monday, the patient called. The patient had seen the neurosurgeon that morning, who confirmed it was a tumor, and ordered additional tests.
Frazier didn't have to send a letter to the specialist explaining why he was referring the patient. The neurosurgeon had access to all that information through the patient's electronic medical records.
Things don't move that quickly in the paper world.
"That's what's important for the patient," said Frazier, vice president of clinical innovation for Riverside Health System.
It's for reasons like this that health-care providers are converting patient charts on paper to patient charts online. These electronic medical records are becoming more prevalent across the Peninsula.
But is the information safe?
The Virginia Department of Health Professions acknowledged a potential security breach April 30 of its Prescription Monitoring Program, which tracks prescription drugs such as highly addictive painkillers in an effort to deter misuse and abuse. The program does not collect or maintain patients' medical histories.
The hacker allegedly is holding the database ransom for $10 million and officials launched an investigation.
Putting sensitive patient information online brings up questions of security, because servers and systems containing personal information are hacked regularly. But the move should make records more secure than the old paper charts, supporters say.
"We could have no idea whether the janitor who came in at night to clean took a look at the records," Frazier said.
With the electronic system, there are "layers upon layers of security" that protect against hackers, he said.
In older models, electronic records systems show up in the form of desktop computers in patient rooms, but that leaves patients alone with the computer.
So doctors must hit a "hide" button to safeguard patient privacy, or it times out automatically. Then, they must enter a password to get back in, he said.
Now, doctors are switching to portable devices that aren't left in the room with the patient. Frazier uses a tablet computer that comes with a fingerprint reader to log him in. He can write on the screen like he would a piece of paper, using a handwriting-recognition program to fill in the chart. Others dictate into pocket PCs with voice recognition that's transcribed into the patient's record, Frazier said.
Two people can't be in one patient's chart at the same time, and that adds a layer of accountability and database integrity, Frazier said.
Then there's the question of who gets access to your files. Sentara and Riverside systems can track who accessed your records, and frequently run special audits to ensure that no one is looking at information they shouldn't be privy to.
"If you want to, we can show you exactly everybody who touched your record and what they did," said David Levin, a Sentara vice president, doctor and senior medical director.
"We couldn't do that in the paper world. The Sentara view is that we have to be very strong guardians of this. It is the only way this can be successful."
Riverside has fired employees who accessed files they shouldn't have, Frazier said.
A patient of Frazier's, Janice Britt said she likes the electronic system and doesn't worry whether her electronic records are secure.
"He has been able to look at things and pull up medical history rather than thumbing through files," she said during a recent doctor's appointment. "I just think it's a wonderful tool."
She especially likes the convenience of myHealth eLink, which lets patients access their medical record and correspond with their doctors.
The system alerts her when test results are in, the 55-year-old Newport News resident said. That's easier than navigating an automated phone system, leaving a message and waiting for someone to call you back.
"Just being able to get the results of your testing without having to call, without having to come in, it's helpful," she said. "It's like a right-at-your-fingertips kind of thing."
The great thing about electronic medical records is that they can give your doctors the most comprehensive information about your medical history.
The problem is, those records don't always travel between health systems.
The economic-stimulus package, the American Recovery and Reinvestment Act of 2009, calls it a priority for health information systems across the nation to communicate with each other.
Say you run into a health problem on vacation. Doctors in other systems won't be able to access your complete electronic medical record. Or perhaps you're a military member who's referred to a physician or specialist outside the military network. Those records won't be able to go back and forth between the military and the other health system.
The next step in the evolution of electronic medical records, then, is sharing them. Riverside was recently involved with testing a system that would share information with the military through a storage platform such as Google Health or Microsoft HealthVault, Frazier said.
Sentara, on the other hand, is working with a vendor that has captured some of the largest health systems in the state, Levin said. That will make it easier to share records between systems, he said.
Sentara is already seeing results. After switching to electronic records, the South Hampton Roads hospitals cut the time it took for patients to get a new medication to 30 minutes, from an average of 137 minutes, Levin said.
"We got rid of about 100 minutes of that process. We eliminated a bunch of paper, we eliminated people pushing that paper around, to focus more on care," Levin said. "Our patients are getting their critical medications more quickly. Quicker care is better care."
In physicians' practices, it isn't easy to make the switch from paper to electronic records. For Riverside Hilton Family Practice, it was costly and time-consuming, Dr. Peter Anderson said. Doctors have to worry about keying the right patient information into a computer while trying to pay attention to the patient.
So he developed a new approach.
He trained his nurses to take patient histories, which he reviews with the nurse in the presence of the patient. That has not only sped up the process, but improved his quality and patient satisfaction, he said. As a result, he's been invited to speak about the model in venues across the nation, he said.
"It becomes a tremendous asset," Anderson said of his teamwork approach. "It facilitates both our quality of care and the number of patients we can see. Basically, all our patients can see us the day they call us."
What to expect
Efforts are under way at hospital systems across Hampton Roads to create paperless record systems. What it means for patients:
Advocates say doctors can have access to your medical history at their fingertips, with no waiting, reducing the amount of time you spend waiting for medications, test results and more.
Right now, electronic records generally aren't transferable between health systems, but efforts are under way to make sharing a priority, so you could get speedier treatment away from home, or if you switch systems.
New systems are more secure, advocates say, with safeguards on who can access your files. But the recent breach of a state prescription drug database highlights potential risks.
Electronic medical records
Health systems and providers are increasingly phasing out patient's paper charts in favor of electronic records.
Bon Secours Hampton Roads
Bon Secours expects to start rolling out electronic medical records in August at 10 practice sites, with hospitals coming online in 2010.
Riverside Health System
Riverside started converting to electronic records in 1996, and about 70 percent of its physicians are hooked up. Most of the rest will be by the end of the year. Nearly 12,200 patients are enrolled in Riverside's myHealth eLink, which gives patients access to their medical records and physicians.
Last year, Sentara converted more than 40 physicians' practices and three of its seven hospitals to electronic medical records. Sentara Norfolk General Hospital went live March 27. Sentara Williamsburg Regional Medical Center is tentatively scheduled for Sept. 12, and both Sentara CarePlex Hospital and Sentara Port Warwick are slated for Nov. 7. More practices will be converted this year. About 2,500 patients have signed up for MyChart, which gives patients access to their medical records and physicians.
Small Physician groups
Because an electronic records system costs upward of $25,000 to set up, it's harder for small physician groups to get on board. According to a 2007 report, only about 5 percent of small physician groups and 15 percent of larger groups nationally are up to speed, said Robin Cummings, assistant director of health policy and research for the Medical Society of Virginia.
Published: May 10, 2009