Dr. Brett White practices medicine differently than he did three years ago.
That鈥檚 when the Gabriel Park Family Health Center in suburban Portland adopted electronic medical records.
White, who oversees the clinic, says the effect was immediate. The electronic records made data available that highlighted patients who鈥檇 been diagnosed with chronic diseases like diabetes and then hadn鈥檛 been seen for a couple of years.
White described the stark realization: 鈥淥h my goodness! We really need to reach out to that patient and make contact and bring them in to provide the care that they need.鈥�
Some of the patients, he says, had taken their doctor鈥檚 advice and were fine. But others were in trouble: 鈥淭here were 鈥� individuals who unfortunately had sustained some pretty significant medical complications.鈥�
Now, says White, their computers track those patients and make sure they get their cholesterol and blood sugar checked on a regular basis, as well as any other preventative treatment they need. It is just the kind of change in practice that the federal health law is trying to encourage with generous financial incentives for providers who adopt electronic records.
White鈥檚 colleague, Dr. Scott Fields, described how the data is used to grade physicians on their performance. 鈥淢y score card he gets to look at, and I get to look at his,鈥� Fields says. 鈥淎nd my nurse gets to look at mine, etc.鈥�
Fields says doctors tend to be competitive and, at first, the grading was difficult.
White cringes remembering his grade for getting women to take their regular mammography exams. 鈥淚 think we鈥檙e biased a bit as clinicians where we think we have a really fantastic relationship with our patients on a one-to-one basis, when we鈥檙e seeing them in the room,鈥� White says. 鈥淏ut to 鈥� see that there are areas, and in some cases significant areas of deficiency, it was a little disheartening.鈥�
But White says, once most doctors saw how grading could help them improve, they were won over.
Dr. Tom Yackel is the chief health information officer at Oregon Health and Science University. It runs the clinics where White and Field work.
Yackel says the whole health care industry has been painfully slow to adopt electronic medical records: 鈥淲e鈥檝e been on par with industries such as mining, which aren鈥檛 well known for their investment in information technology. And if we compare ourselves to banking or insurance, they may spend two, three, four times as much as health care on information.鈥�
Part of the reason, Yackel says, is that medical records are complex聽鈥� they don鈥檛 just involve dollars and cents聽鈥� they involve medications and personal histories.
But there鈥檚 another reason electronic records haven鈥檛 been widely adopted by hospitals.
When you ask the question: Is digitization good for a health organization鈥檚 bottom line? Yackel says the answer is: It depends. Are you鈥檙e talking about a hospital, the Veterans Administration, or an insurer?
鈥淚t has to do with who gets the benefits,鈥� he said. 鈥淲hen the VA is able to do that, when [an insurer] is able to do that, they lower their costs 鈥� When a hospital that runs on fee-for-service medicine聽鈥� they get paid for what they do聽鈥� they get paid less.鈥�
So, electronic records may not be a great investment for a hospital, if you are just looking at the bottom line. But they are good for whoever is paying the bill. That鈥檚 a lesson the Obama administration has taken to heart in its overhaul of the health care system. So now, it鈥檚 giving clinics and hospitals millions to give them an incentive to use electronic medical records.
And that, says Yackel, is generating mounds of data that can be mined to both save money and improve a doctor鈥檚 performance: 鈥淗ow well are their patients being immunized against influenza and pneumonia? How many of their patients have had their mammograms, their pap smears, their preventive care screening? What percentage of patients have x-rays or images of their back that鈥檚 not considered appropriate for low-back pain treatments. We鈥檙e just starting to gather that data and figure out how we use it to change practice.鈥�
Now, he says, patients can log onto their computers to see their own charts, check their lab results or schedule mammograms. And that, Yackel says, stands in stark contrast to 10 years ago when he remembers wasting a significant slice of his day just trying to find each patient鈥檚 chart.
Back at Gabriel Park Family Health Center, Dr. White believes electronic medical records are good for the patient, the doctor and the bottom line. But, he cautions, they鈥檙e not the silver bullet that will slay all the nation鈥檚 health care problems. 鈥淚t鈥檚 challenging to interface with a computer when you鈥檙e in a room with a patient,鈥� said White. 鈥淏ut also spending a lot of time outside of the room typing. So, I don鈥檛 think we鈥檝e hit sort of the ideal just yet.鈥�