Clinicians Urged Not to Wait for Perfect Technology

SALT LAKE CITY—Health advocates clamoring to substitute paper charts with electronic ones are shortsighted. That’s according to Rick Peters of the American Academy of Family Physicians, who gave the keynote address this week at Toward an Electronic Patient Record, an annual conference sponsored by the Medical Records Institute.

The health IT community needs to stop waiting for universal consensus on standards for document formats and data exchange, he said. “Take a solution that isn’t perfect, and just do it.”

But simply turning a paper chart into an electronic one is not necessarily a solution, Peters said. To be a solution, technology must make patients healthier, make clinicians’ lives easier or make health care more efficient.

That means that electronic medical records should open up new ways of providing health care, or at least change the way that medicine is practiced so that wasteful processes are either eliminated or automated.

In a later session, David Trachtenberg, a physician with the Methodist Medical Group, echoed this sentiment. When his 31-site practice moved to electronic prescribing, he said, the focus was on office efficiency, not on replacing the paper chart.

Ultimately, he said, the process of getting a prescription filled decreased from 27 steps with a paper system to 15 with an electronic one. The number of times patients’ charts had to be pulled to refill prescriptions dropped dramatically, from 266 a month to 11. (Another physician at the conference estimated that pulling a patient chart could cost $10 per chart.)

Nonetheless, Trachtenberg said, the transition took two years, and it’s not over. Processes must be streamlined continually. “Workflow redesign has to be done over and over again.”

At his keynote, Peters of the American Academy of Family Physicians said the real barriers to productive health IT are greed and “technology bigotry,” which keeps groups from compromising on solutions and distracts experts from finding them. “People tend to think ‘Where can I carve out [a way to make] money?’ rather than talking about core issues,” he said.

Trachtenberg also blamed health care providers for clinging too tightly to their data. Closed proprietary networks should be replaced with the Internet and wireless technology, he said. Also, physicians must get rid of legacy systems. Keeping them tends to make data useless or worse, he said, because few physicians are going to access data if it requires logging on to separate systems with several different passwords.

Peters dismissed the idea that privacy concerns and the unwieldy complexity of the health care systems represent real barriers. While there are legitimate issues in these areas, he said, they are mainly being used as excuses to do nothing.

For example, he said, patients should be able to maintain electronic medical records kept by their physicians. Patients could make their existing records more accurate and complete in as little as 20 minutes he said.

Peters discounted claims that doctors would reject such records as untrustworthy, countering that doctors would embrace the practice as long as they could know that a record had been changed and not be held liable for acting on incorrect information.

At a later session, C. Peter Waegemann, CEO of the Medical Records Institute, chided clinicians waiting for better technology to become available. He said practitioners should buy technology that will solve problems they are facing today. “If you can identify the benefit, you should be happy if something is better in a year to replace it.”

Peters said the vendors need to do their part as well by decreasing providers’ risks in buying technology. “Vendors need the guts to let customers walk,” he said, by keeping a looser hold on clients’ data and money.

Ultimately, the high cost of health care and the pain it incurs on both employers and employees will force a change in the services doctors provide and how they are paid. Technology could make this a change for the better.

But so far, he said, the process is taking way too long. “We are 21 years into technology, and have only about a 20 percent penetration.”

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