Medical records `still in buggy era'

Goal: President Bush announces the daunting task of putting most patients' histories on computer files within 10 years.

Medicine & Science

May 03, 2004|By Julie Bell | Julie Bell,SUN STAFF

In the world of medical high technology, there is arguably no hotter intersection than Baltimore and Greene streets.

On one corner, the Baltimore Veterans Affairs Medical Center has virtually eliminated the need for patients to haul X-rays or paper charts from one VA appointment to the next. Instead, doctors and nurses use computers to summon screens of CT scan images, lab test results and medication histories for any patient seen at hundreds of VA hospitals and clinics nationwide.

Across Baltimore Street, University of Maryland Medical Center employees click into patients' records on wireless computers set atop rolling carts. Rosie the robot fills prescriptions in the pharmacy. Mr. Gower, another robot named for the druggist in the movie It's a Wonderful Life, putters alone through the Maryland Shock Trauma Center, delivering medicine.

Even so, President Bush, who highlighted such technological advances in a visit to Baltimore last week, acknowledged that meeting his goal of electronic records for most patients within 10 years is a mammoth task.

"We're kind of still in the buggy era," Bush told an audience of 140 doctors, veterans and others at the VA center.

Experts agree that electronic health records can help reduce the medical errors that kill an estimated 98,000 U.S. inpatients every year. Advocates say they can also improve efficiency and reduce costs by decreasing the number of redundant medical tests ordered when doctors can't gain access to paper records stored elsewhere.

But privacy concerns, a lack of common standards for patient records and the expense of going digital have kept the nation's health care system far behind its financial institutions.

"Most medical practices are still like Marcus Welby," said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, a government research organization. "Only 5 percent of doctors have electronic medical records."

Much of Bush's proposal has yet to be worked out, though the president pledged to appoint a Department of Health and Human Services official to develop and coordinate a system of computerized health records. Already, one HHS committee has developed a strategy for a national health information infrastructure. The plan includes a digital personal health record controlled by patients.

Some programs are expensive in part because they're so sophisticated: Many flash warnings if doctors enter a prescription that might interact harmfully with another drug.

Elias A. Zerhouni, director of the National Institutes of Health, said the administration's initiative could also make clinical research more efficient, affording physicians easier access to data on the effectiveness of treatments.

But the difficulties are apparent even to those who have made advances. Computers at the University of Maryland Medical System's downtown campus, for example, can't talk with all those in the system's five other hospitals, or with those at unaffiliated health facilities.

About a mile away at the Health Care for the Homeless Clinic, doctors rely largely on paper charts while planners try to figure out how to raise up to $1 million to convert to an electronic system. When the clinic's nurses visit homeless shelters, they can't pull up patient records. Said spokesman Kevin Lindamood: "They're locked up back at the clinic."

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