Feb. 22Dr. Thomas Lee doesn't use much paper at work anymore.
When the chief of pediatric surgery at Stony Brook University Medical Center wants to order a prescription, he goes to one of the hospital's 422 computers on wheels COWS is the industry acronym and types it in. Concerned that patients might not like the sound of "COWS" in their rooms, Stony Brook prefers the acronym RICS roaming interactive computers.
The computer shows Lee information about the patient, including allergies, previous tests and medicines given, and checks that Lee has chosen a dose based on the patient's age, height and weight.
"It avoids the issue of handwriting," said Lee of the $30 million to $40 million system that went live at Stony Brook a few weeks ago. Illegible handwriting contributes to errors and wastes time tracking down doctors, Lee said.
Only two on Long Island
Reducing medical mistakes, becoming more efficient and saving money is the great promise of electronic medical records systems. Nationwide, 2.5 percent of hospitals have a system as sophisticated as Stony Brook's, according to HIMSS Analytics, which collects health care information technology data. So far on Long Island, only Winthrop-University Hospital in Mineola has a comparable system.
The $19 billion allocated for electronic medical information technology, or IT, in the federal stimulus bill should put far more medical records online.
The money has not been without controversy. Some Republicans say it's a sneaky way for Democrats to transform health care without debate though former Republican President George W. Bush in 2004 called for all hospitals to be wired by 2014, a goal President Barack Obama has adopted. Consumer groups had been concerned about patient privacy, especially if the records systems become interconnected. What's more, studies have found problems with the new systems.
But the initiative has undeniable momentum: Under the legislation, hospitals that have not begun using health IT by 2014 will not get full Medicare reimbursements beginning in 2015.
New York State is 17th nationwide in installing paperless patient record systems, says HIMSS. That is because New York has a high number of hospitals it ranks fourth among the states and many of those institutions are older and more difficult to retrofit with electronics.
"The stimulus money will be critical," said Dr. Aaron Glatt, chief executive of New Island Hospital in Bethpage. The hospital, facing a $2.23-million cut in state reimbursements, has little money to move forward with its proposed $10-million system, he said.
May help create jobs
And, because skilled people will be needed to install and maintain the systems, the money should create jobs. Bob Chaloner, chief executive of Southampton Hospital, said he could envision adding 25 to 30 employees to the three hospitals if the East End Health Alliance which includes Southampton, Eastern Long Island Hospital in Greenport and Peconic Bay Medical Center in Riverhead gets enough stimulus money to help implement a $23-million IT plan for the three hospitals.
Electronic record-keeping is expected to reduce medical errors and lower costs by dispensing of unneeded tests the thinking is doctors won't order some tests if the patient record is flickering on the screen in front of them. But a 2006 study in the journal Pediatrics found an increase in children's deaths after the University of Pittsburgh began using a computerized physician order entry system at its children's hospital.
Yet hospitals that have the most experience with the new systems say have learned from others' mistakes.
"You have to be careful of the inflexibility of computers," said Michael Oppenheim, chief medical information officer at North Shore-Long Island Jewish Health System. "You have to build in flexibility," and allow a doctor to override the system when he wants to, say, order a different dose of a drug.
By June, nurses and other support staff will be operating without paper at Long Island Jewish Medical Center and Schneider Children's Hospital, Oppenheim said.
Maureen Gaffney, chief medical information officer at Winthrop, said the hospital saw improvements almost immediately after it rolled out its system in 2005 to most departments. Telephone orders for tests and prescriptions easy to misunderstand went from 14 percent to less than 1 percent within a month, she said.
As for privacy concerns, Ashley Katz, executive director of Patient Privacy Rights of Austin, Texas, said the advocacy group, at first concerned, was pleased with the final bill, including prohibitions on the sale of patients' records without their permission.
At Stony Brook, one patient has already noticed a difference. Michael Tyson, 41, of Freeport, said the nurses less busy confirming doctors' orders and able to push COWS into his room to look at his charts were able to respond more quickly to his calls. "And they're more cheerful," he said.
Privacy safeguards
Even as it pushes medical record-keeping into the electronic age, the stimulus package seeks to protect patient privacy. Among other things, it:
States that the existing federal medical privacy law covers electronic records.
Prohibits the sale of medical records without consent and limits marketing.
Requires health care providers and others to keep
an audit trail of those with whom they share patient
information.
Requires notification if a patient's records are breached.
- RIDGELY OCHS
Faster than pen, paper
Here's how medications are delivered via a system that uses paper, compared to an electronic one:
ON PAPER
1 Clinician sees patient.
2 Clinician writes order on paper.
3 Medication order sent to pharmacy.
4 Pharmacy enters order into computer.
5 Pharmacist reviews and verifies order.
6 Nurse signs off on order; if there are questions, contacts clinician for clarification.
7 Nurse transcribes medication order to paper Medication Administration Record.
8 Second nurse looks at transcription to ensure accuracy.
9 Nurse goes through "5 rights" check: Right patient, right medication, right dose, right route, right time.
10 Nurse gives medication.
ELECTRONIC
1 Clinician sees patient.
2 Clinician enters order into computer; medication orders go directly to pharmacist. Alerts pop up on screen for dose range, any drug allergies or duplicate
ingredients.
3 Pharmacist verifies order; contacts doctor for clarification if needed.
4 Nurse goes through "5 rights" check: Right patient, right medication, right dose, right route, right time.
5 Nurse gives medication.
Source: Stony Brook University Medical Center
