Computerized patients records

By Henry C. Fader, Esq.

As computers start appearing in the clinical side of the physician’s office, more physicians become conversant with new information technologies and Internet usage become the norm, many distinctly different systems are emerging to assist physicians in providing clinical care to their patients.

Let us look at one typical patient encounter employing computer technology. Mrs. Whelan, a new patient, comes into your office on Monday morning. She was referred to you by her general practitioner after she visited the emergency room of Valley Hospital over the weekend. Tests were ordered at Valley Hospital and the results of those tests are now available. Your computerized time scheduling list causes you to look up Mrs. Whelan’s computerized patient record (CPR). The treatments given by her general practitioner and the hospital over the last several days all appear in the CPR. Mrs. Whelan’s chronic conditions of high blood pressure and diabetes have triggered patient packets with ticklers as to appropriate warnings and life style changes that Mrs. Whelan needs to make. You review her CPR automatically for the medications she is currently taking and additional reminders suggest alternatives automatically. All of the physician notes from each of her physician and hospital visits are also reviewable on the computer monitor at your desk. Mrs. Whelan enters the office and you proceed with her history, examination, diagnosis and treatment.

Is this a scene from some futuristic movie or novel? No, it is a fairly typical office visit at the Kaiser-Permanente of Ohio system, a group model HMO. Kaiser has recently implemented its MARS system that produces computerized tracking information on all patients and then scans handwritten physician notes into the system for immediate reference. This fairly unconventional approach to the development of computerized patient records received one of three Awards of Excellence at the Third Annual Nicholas E. Davies CPR Recognition Symposium held in Washington, D.C. This symposium, sponsored by the Computer-based Patient Record Institute on June 19-20, 1997, focused on three outstanding efforts to develop computerized patient records that can be easily used by all clinicians and provide information useful to them when caring for their patients.

Kaiser decided to begin development of a medical automated record system in 1989. It is currently a 200,000 member organization. After extensive development of software and hardware and the training of all personnel, including physicians and office workers, Kaiser was able to initiate an encounter system comprised of core data elements and an alert system that tracks test abnormalities, identifies risk factors and generates reminders. It also provides access to current and accurate medical treatment information and serves as a tool for disease and population management. The goal is to enhance the health dollars spent and head off conditions that require extensive inpatient care and emergency visits.

A second award winner at the CPR Symposium was North Mississippi Health Service (NMHS). NMHS has been developing a different approach to CPR over the last twelve years. Its system is designed to allow practitioners at any one of its 120 different locations within its health care delivery system to have access to a permanent patient record with pertinent information concerning each of its patients. Each patient in the NMHS system maintains an identification card with a particular patient identification number. That number gives the clinician access to both episodic and lifetime patient records.

Since the NMHS system covers such a wide range of providers and facilities, NMHS can also collect data on costs to deliver care and the incidence of particular types of ailments. They have also developed an internal system called Cost Information Decision Support (CIDS) which takes retrospective decision information from a financial and clinical perspective to permit its clinical efficiency department to improve care and lower costs. As more and more of its clinicians become computer literate and add information to the system directly on-line, it is expected that CPR and system wide information will become more and more useful. NMHS expects to utilize CIDS and CPR to significantly control operational and clinical costs for managed care while giving access to more information to its clinicians.

The interest in computerized medical records initially began from medical records and information management departments in hospitals focused on the need to replace the paper based system and lower costs of maintaining medical records. The passage of the 1996 Health Insurance Portability and Accountability Act has accelerated the work of the U.S. Department of Health and Human Services (HHS) to adopt standards for the electronic transmission of financial and administrative transactions in the health care system. Initially, these HHS standards will relate to financial and administrative data. Ultimately they will have a profound impact on broader computer-based health records and data standards. This is especially true in the area of health claims where claims attachment typically consists of a patient’s entire medical record, laboratory results and radiology information. The National Committee for Quality Assurance, the organization which oversees managed care plans, has also been laying the groundwork for collection of computerized patient data. Concerns over security and patient confidentiality continue. The National Research Council recently published guidelines to protect patient data today. It is anticipated that the push from the federal government to put computerized data in place and to develop standards for security and confidentiality protections will result in the implementation of such systems nationwide.

President Clinton, in his State of Union address on February 4, 1997 said: “We should connect every hospital to the Internet, so doctors can instantly share data about their patients with the best specialists in the field.” Are physicians up to the challenge? Physicians need to develop an open mind to information technology generally and the opportunities that CPR offers them in the care of their patients. Training and education are available from health care systems and organized medicine. It will not be long before many physicians will be having encounters as their fellow physicians are having now in Ohio and Mississippi.

Henry C. Fader, Esq., is a Partner and Chairman of the Health Law Department of Schnader Harrison Segal & Lewis LLP with offices in Philadelphia, Pennsylvania and Cherry Hill, New Jersey.