Medical center makes move to digital record-keeping
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By MEL HUFF Staff Writer - Published: August 5, 2007
BARRE — A wave of change is beginning to sweep through Vermont, and though it may appear invisible to patients, a straightforward new health care technology promises to bring significant improvements in their care. New electronic medical records systems are bringing medicine out of the ballpoint pen era into the computer age.
The transition is already under way in Central Vermont Medical Center where, after three months of preparation, medical group practices affiliated with the hospital will start converting paper files that they've used for generations to electronic medical records.
Dr. Tim Burdick, who is leading the complex and costly transition for the medical center's 44 physicians, physician assistants, nurse practitioners and nurse midwives, used an electronic system before he came to Vermont and understands the benefits of the technology.
"We may have 45,000 patients at all of our offices in the region. We could have the computer print out mailing labels and letters for every woman 40 or older who has not had a mammogram in the last two years," he explained. "Currently, you'd have to pull every chart off the wall and flip through the paper to see whether they've had a mammogram or not. Instead, the system can do this completely automatically."
The system can also keep track of medications and instantly cross-check for drug interactions and allergic reactions. Prescriptions entered from a computer in doctors' exam rooms will show up in pharmacists' computers across town in a matter of seconds, eliminating delays and problems with deciphering handwriting.
Central Vermont Medical Center has already purchased an electronic medical records system for its outpatient offices, at a cost to the hospital of $1,012 million, or about $22,000 per provider. The hospital is assuming the cost, Burdick said.
The first phase – implementing the scheduling and office management system – will take place this month. The conversion of clinical documents will take place over six months, beginning in October.
The hospital is planning to help other doctors who have admitting privileges to convert to electronic records. A recent change in the federal Stark law, intended to prevent conflicts of interest, will allow medical centers to help physicians who refer patients to them adopt the costly information technology. Vice president Daniel Pudvah said the project is part of Central Vermont's strategic initiative.
"These are physicians who send patients to the hospital," Burdick explained. "The patients' medical care is supported by the hospital, so it's easier for the patients as well as all the physicians in the region if there's one system. Financially, it's very difficult for private practices to make the switch to electronic records. It's in the hospital's interest to support the physicians who are on the medical staff … with the implementation of the electronic records." In the case of privately owned practices, the doctors might share some of the costs of implementation, he noted.
Burdick named three obstacles to making the transition.
The first, he said, is the mindset shift – convincing everyone, including patients that electronic records are in their best interest.
Burdick said that if patients don't want to share their information, safeguards can be put in place to ensure privacy. It's easier to maintain privacy with electronic records than with paper files, he noted, because a password is required to access electronic files, and every time an electronic file is opened, it creates an audit trail. "That's a strong deterrent unless you have authorization to look at a chart," he observed.
The second obstacle, Burdick said, is financial, the expense of buying the hardware and software and "getting all the systems talking to each other."
"By having all of the regional offices on one system, we definitely are saving on startup costs," he said.
The third obstacle, Burdick said, is the actual process of conversion – "taking the information on tens of thousands of pieces of paper" and entering it into the computer system.
Some records will be scanned, and extra help will be hired for the medical records staff. "For a period of time, (the conversion) will result in a decrease of productivity in the offices while we go through the transition," he said. "Instead of it taking us 10 minutes to see a patient, we might need to spend 10 minutes with the patient and 10 minutes beforehand getting the chart ready." But, he added, "There shouldn't be such a dramatic change that patients notice."
Burdick said that a "strong majority" of practitioners favor the transition. But even so, he added, "I think there's some apprehension about going through the change. Even if you're in favor of it, it's not always easy."
He noted that Central Vermont Medical Center is dedicated to spending the time required to make sure everyone can master the electronic medical records software. "One of the tricks we hope will help is providing a strong support team," he said.
In other parts of the state, some doctors have reportedly stopped using an electronic system for tracking diabetic patients that requires making two sets of entries.
"If it requires an additional step or extra work, then people are going to be reluctant to use it," Burdick said. "If it's neutral – if you eliminate one piece of work and substitute something else on the computer – then people are willing to do it. Best case scenario, if switching to a computer creates one step but eliminates three others on paper, then pretty quickly people realize there's an advantage to doing it that way."
In regard to the diabetes registry, he said, if a physician uses the hospital's electronic records system to order laboratory work for a diabetic patient, the results should automatically flow into the registry.
Central Vermont Medical Center has allowed Burdick to spend about half of his time working with individual doctors to ease them into the transition. "The bottom line is if the physicians aren't comfortable and happy with it, it won't work," he said, "so we'll do what we need to do."
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