Digital Medicine

The business of medicine has tended to lag behind a bit. The organization of records, the viewing of information and the storage of data are all crucial elements to ensuring not only the success of the medical institution, but also the quality of care. Though other medical technology has advanced quickly, often this section of the medical world has not … until now. All across the country and, thanks to our highly rated medical community, here in East Texas there is a transformation of the medical field outside of the operating room – and we will all be the beneficiaries.

It seems like every two weeks the news media reports a significant jump forward in technology and know-how in the medical industry. The combination of brilliant scientific minds and an insanely varied and often profitable business can set the perfect scene for advancements improving the quality of care and life for people across the region, state, country and world.
However, the business of medicine has tended to lag behind a bit. The organization of records, the viewing of information and the storage of data are all crucial elements to ensuring not only the success of the medical institution, but also the quality of care. Though other medical technology has advanced quickly, often this section of the medical world has not … until now. All across the country and, thanks to our highly rated medical community, here in East Texas there is a transformation of the medical field outside of the operating room – and we will all be the beneficiaries.

Paula Anthony, Vice President and chief information officer for ETMC regional health system, said that this transformation is taking place on a grand scale. “In general, the health care industry is undergoing this massive shift toward the use of information technology to streamline the activities of documenting patient care, of managing patients’ clinical activities, and hopefully improving their outcome as they have more information that’s available to them electronically,” said Anthony. “...A vast majority of hospitals and physician’s practices still rely on cumbersome paper charts, so they have to dig through tens of thousands of cases a day to find what they need to make the right clinical decisions. Lots of work is going on right now to capture, store and manage all these data electronically so that the information that’s most important is most readily available to the physician. You layer on top of that, technologies offer different kinds of alerts so that when physicians, for example, are placing an order the systems will automatically alert if there might potentially ... be a complication with or a potential interaction with an allergy that that patient might have, or with another medication that that patient might have.”

Anthony also described a broad spectrum of medical services including digital prescription (and verification of pickup if needed). She also mentioned that while there has been immense activity going on for the past 10 years, in the past two to three years the level of momentum has snowballed due to some federal stimulus dollars that have been put in place to help physicians and hospitals adopt these new technologies.

Dr. David Jayakar is Director of Cardiac Surgery at the Diagnostic Clinic at Longview Regional Hospital and adopted EMR (electronic medical reports) early because he saw the advantages these changes could bring.

“EMR is everywhere,” said Dr. Jayakar. “The advantage of EMR is initially when I had a paper chart, each paper chart costs me about lets say $5 to make that chart. That includes the paper, the cardboard and filing them and so on. If I have 1,000 patients, that pays off as a profit ... The second beautiful thing is I can access it anywhere I go if I have an EMR. That means if I am in another hospital or wherever I am, on the Internet I can access it – with proper security.”

Anyone that checks in at a doctor’s office has seen the file folders and cabinets stacked from floor to ceiling, row after row. Perhaps the best part of EMR is straightforward: it just makes life easier.

“The best part ... you don’t have to maintain records in a physical location,” explained Dr. Jayakar. “With the EMR [the data] is always there, for many years, as many as you want ... that makes things much easier for [offices] because, physically, they don’t have to store these charts.”

Utilizing technology enables the transition to what he calls an “electronically transparent office.” Dr. Jayaker said. “We have our faxes coming electronically, so nothing is printed – there is not even a printer in the office. Everything gets put in the EMR without even one paper being printed. So, thats got a lot of implications on the cost, being ‘green’ ... By doing this we are able to insist that every piece of information goes digitally, because even though some offices claim they are going to EMR, they still print a lot and scan it and waste that paper ... It’s also healthier for the office, that’s what we noticed. These files collect dust and notoriously the file rooms are dirty. With the EMR, its a clean, uncluttered office we try to give to our patients.”

John Moore, Public Information Officer for Trinity Mother Frances Health Systems, said they are also on the verge of implementing their own enterprise-wide change with the Epic system. It’s main feature is an integrated and unified patient-centered database. Patients will benefit by having their clinical information available to the caregivers at every point of care across the system: inpatient, outpatient, ambulatory, community, and regional locations. In addition, physicians can affiliate with Trinity Mother Frances through the use of the EHR (electronic health record) by adopting the Epic system in their practices.

Entire rooms full of forms and folders can be saved, backed up and processed on a single hard drive the size of a shoe box. It’s a logistical dream come true, and basically, it comes down to solving one of the main complaints of the medical field: management of resources. Without the hassle, space constraints and potential for misinterpreted or lost information, physicians can focus on caring for patients, and not operating a document storage facility. However, the function and broad use of EMR holds more potential than just turning paper files into digital ones. There are wide-reaching effects on everything from digital imaging to continuity of patient care.

Dr. Jayakar cited an example: “Let’s say I have to repeat an open heart surgery that was done 10 years ago. I call the physician to get medical records – but they are only bound to [hold onto those records] for 7 years … With that in mind we are able to maintain that continuity with the EMR because in the EMR [important information like that] is always highlighted … Regarding the digitization of images, that is a very great move because now instead of going to the X-ray department only to see the X-rays, we can see the X-rays anywhere you want,” Dr. Jayakar pointed out. “Consequently, patient care has improved dramatically.”

And while there are some cons, the experts believe mostly they don’t come close to outweighing the positives – they are just issues to be overcome when facing a large-scale transition. These include learning new computer systems, the initial cost of the computers and storage media and the networking. Anthony said there is one hurdle that is no small concern for any institution looking to embark on the digital journey: “They’re unbelievably expensive. Unbelievably expensive,” Anthony repeated. “Hospitals spending tens of millions of dollars to get them implemented – physicians’ offices not that much because they’re not as complicated. But still, these are very, very complex systems to implement and they take a long time. So some of these stimulus funds are being offered as incentive to help to pay for at least the initial capital outlays associated with putting theses systems in and encourage people to adopt them because there’s a lot of evidence that shows that those facilities and those clinical services that utilize information technology over time seem to have better outcomes, more consistent performance … and it’s easier to assess the quality of the care that’s being given because its a little bit more objective than just trying to monitor people’s notes, it reduces illegibility concerns that can sometimes lead to patient errors, you know. In general if you can use technology just like with any other business it can improve the quality and hopefully the safety and outcomes of the patient experience.”

So, perhaps a casual observer might ask what in fact is taking so long to make the switch over in larger systems, other than cost? Well, the problem at hand isn’t terribly complicated, it’s just that the implementation of the solution is incredibly labor intensive.

“These technologies are, as I said, extremely complex,” explained Anthony. “Clinically, if you look through a patient’s chart there are literally thousands upon thousands of data elements ... You don’t want to capture imperfect data and put them in a computer, because that’s just not going to help you. So the reason it’s difficult is because you have to go through a pretty significant work flow changes to capture these data.” Anthony continued, “Years ago, the way hospitals used to do it was to just scan it all ... and while that makes the data available if you’ve got a PC or some device, it doesn’t let you action on those pieces of data. It doesn’t do any kind of checks, drug/allergy checks, any kind of things that will help improve the experience of the patient. So, those technologies have really been eclipsed by a much more modern approach, which is to capture actionable data at the time you’re treating the patient, at the time you’re placing an order, at the time you’re looking at lab results, at the time you’re reading a radiology interpretation, capture that data as something that is actionable that will drive a clinician to have the information he or she needs to make a clinical decision.”

The methods of viewing these records is also taking large steps forward. With new methods of viewing patient information and images (like MRIs) are making gains. Dr. Jayakar has been developing a system and software using his iPad as a portal to view files in place of multiple paper folders. Currently, there are two types of software for this purpose. First, the information is stored with cloud-based software. The other option is to have a dedicated program that communicates via iPad only – though Jayakar believes the cloud-based setup is the future.

Though at first glance it might not seem like such a huge improvement in medicine, the sheer scale of the transition and the time, money and administrative efforts that the digitization of medicine opens up for physicians of all types simply cannot be underestimated. Dr. Jayakar compares it to a full lifestyle change. “There is going to be a generation of doctors that are used to the old paper charts,” he said. “Now you are going to have another generation of doctors that are going to be with the EMR and those benefits. We are right in the transition now. It may take another few years, but then the new doctors and the old doctors will conglomerate.” He compares the transition to air travel: “The old planes were not even pressurized, they were noisy and few people were riding in them. Now, we have jets that can take 600 passengers at 40,000 feet across an ocean with no noise. That didn’t happen overnight. It took a while ... and thats the change we are going to get used to.”

It’s a change everyone will have to adopt. Anthony described this evolution as “a train gathering momentum.” And, like everything else digital, it will to become ever-more individualized and accessible – like personal health records stored in a cloud-like system from a company like Microsoft or Google with data populated by the patient, as well as the institutions that care for them. As patients become far more involved in the management of their own care, the demand for access to information and the ability to chart their own history and care grows as well.