December 16, 2012
Better Healthcare Coming our Way on the Big Island
By Hawai‘i Island Beacon Community
HILO, Hawai‘i – “I don’t have just one doctor. My regular doctor referred me to a couple of specialists, and I’ve also seen some different doctors in the hospital. And every office I go to, I’m asked the same questions, and fill out the same forms, over and over again. Don’t these people talk to each other?”
The surprising answer is that there is a good chance that they don’t, at least not as effectively and efficiently as you might have thought. Sit with a bunch of doctors, and you’ll hear how old-fashioned the healthcare system is (compared to the computer age that we think we live in), when it comes to making information available when and where it is needed. That can be frustrating for the patient, who may or may not be in a condition to describe vital details. It is equally frustrating for the person giving the care, trying to do the best job possible for each and every patient asking for help, but dealing with lost charts, illegible writing, forgotten data.
The solution, at least in theory, is the computer. “Information technology” has transformed our lives in countless ways, from how we bank, to how we shop, to how we interact with friends and acquaintances. Why not use the computer to improve healthcare, too, by first, organizing the information the provider requires; second, making it available as needed at the touch of a button or click of a mouse; and third, reducing the need for filling out endless, repetitive forms?
This is the direction that healthcare is taking. With financial incentives from the federal government, many if not most hospitals, clinics, and offices are converting from paper to electronic records. This actually is happening more rapidly in Hawaii County than in most jurisdictions nationally, and can be very important in creating a new approach to healthcare. As an example, think of the value of preventive medicine, then consider this comparison: Suppose a doctor with 2,500 patients wants to identify all his female patients who are overdue for a mammogram, or all his male patients who are overdue for a prostate exam. If the doctor uses paper records, imagine how much time it would take to identify the patients who need to be notified. Then consider how much faster those patients could be identified if the records were kept digitally. The paper record search would be so difficult that it probably wouldn’t be done at all; the electronic record search would be a matter of seconds, and sending out electronic reminders to the patients might be just as swift, making it much more likely that it will actually happen.
But converting each practice to electronic records is only part of the plan. In the above example, the doctor, using just the record she keeps on her patient, can bring some measure of better care to that patient. But now suppose that the doctor has access to all of a patient’s health history, lab results, medicines prescribed, etc., from other doctors that the patient has seen. With such a complete picture, and if the information is in a usable format, it is not hard to imagine that the care provided to that patient will be better because of the increased knowledge. If that complete record is also available to the hospital, and the patient is brought to the emergency room in a condition that makes it impossible to answer a doctor’s or nurse’s questions, the benefit is more obvious. But even in a less dramatic situation, when a patient has multiple medicines, has had numerous tests, and simply can’t remember them all, it would be a great improvement to know that the facts are available at the physician’s finger tips.
Once records are kept digitally, it is theoretically possible to combine a person’s information into one comprehensive record, and then make it electronically available to the doctor when needed. Each time the person gets more care, the record grows and is continuously updated in real time. When the family doctor makes a referral to a specialist, the specialist can quickly and easily learn what she needs to know about the patient, perhaps even before the patient arrives. When the specialist makes a diagnosis, recommends a treatment, or prescribes medication, the information is added to the record and is readily available when the patient comes back to the family doctor, and nothing gets lost in translation. That is the potential when electronic health records are taken to the next step—taken beyond the walls of an individual hospital, clinic or office, and combined in what is generally called a “Health Information Exchange.”
But how far have we gotten in establishing these Health Information Exchanges? Not as far as we would like. Why not? And what about a patient’s privacy? Next time.