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Electronic Health Records Gaining Acceptance

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By Elizabeth Gardner, for U.S. News

When her 5-week-old daughter Scarlett was hospitalized in March with a potentially life-threatening respiratory virus, Melissa Marote of Canoga Park, Calif., was too distraught to remember everything the doctors and nurses told her. Fortunately, she was able to access her daughter's complete medical records, 24 hours a day, via computer or smartphone through a member portal called "My Health Manager" on kp.org, operated by Kaiser Permanente, which serves as both health insurer and care provider for 8.9 million people in nine states and the District of Columbia.

Marote can review test results and care instructions, request prescription refills, schedule appointments, and swap secure E-mails with her family's doctors, which she does frequently. "They're very good about getting back to me, no matter where I am," she says.

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Kaiser is a leader in giving patients online access to their medical information, but this type of access is spreading quickly. "A lot of people have been concerned that technology would put more distance between doctors and patients, but in our experience it brings them closer together," says Phil Fasano, Kaiser's chief information officer.

The 2009 American Recovery and Reinvestment Act provided $20 billion in incentive payments to physicians and hospitals to accelerate their adoption of electronic health records, or EHRs. About 3,500 hospitals and 150,000 physicians have registered for the program. The government will keep paying the incentives for the next several years, but after that, it will cut Medicare payments to providers who don't use EHRs. "This is a huge change—hospitals are adopting EHRs rapidly and trying to figure out how to use them effectively to improve care," says David Bates, chief quality officer at Brigham and Women's Hospital in Boston. "It's a very exciting time."

How will electronic recordkeeping change things for patients? These are some key ways:

All-in-one file. Donna Gaidamak was diagnosed four years ago with adenocarcinoma and receives her care through the Kellogg Cancer Center at NorthShore University Health­System in Evanston, Ill. Kellogg has had its current electronic health record system since 2003. "I feel reassured knowing that everyone who's helping me is tapped into a system where they can see everything that affects my care," she says. For example, Gaidamak is allergic to a dye commonly used for CT scans of the chest, and all her providers see this information when they open her records.

NorthShore chief information officer Steven Smith estimates that over 60 percent of emergency room patients already have an electronic record in the system when they come in the door. Thus, the attending physicians can instantly access critical information like medication alerts, allergies, and existing medical problems—saving time, money, and even lives.

Electronic prescribing. Your doctor can transmit prescriptions directly to your pharmacy, often in time for you to pick up your medication on the way home. Last year, more than 570 million prescriptions—about 36 percent of the total—were routed electronically, according to Surescripts, the secure network that carries the vast majority of electronic prescriptions between healthcare providers and pharmacies.

24-hour access. Jennifer Brown, an executive assistant at University of Pittsburgh Medical Center as well as a patient there, received the results of a recent test via smartphone while her doctor was vacationing abroad. In a paper-based system, she would have had to wait until the doctor returned, reviewed the result, and sent her a copy in the mail. Brown uses UPMC's HealthTrak patient portal to keep track of information on her children (ages 13, 10, and 9) and her 79-year-old mother. The system lets her print a wallet card with all her mother's medications—a huge improvement over the handwritten list on paper the family had previously used. She can print out a new card whenever her mother's meds change.

Smarter decision-making. By looking at information from thousands of patients (much easier to do with computers than by collating paper reports), health researchers can identify which treatments work best, and EHR systems incorporate that information to help your doctor treat you. For example, the EHR used at Brigham and Women's recommends medication dosages based on the patient's level of kidney function as determined by lab tests. "That has really improved the safety of giving medication," Bates says, noting that the hospital has cut half a day, on average, from the hospital stays of patients who have renal issues.

Avoiding errors. EHRs aren't infallible, though experts agree that merely removing physician handwriting from the process improves accuracy and reliability. Still, providers are learning how to avoid the mistakes that can occur via computer: an incorrect drug chosen from a pull-down menu, the wrong choice made on a checklist, information for one patient entered into another's record. A recent Institute of Medicine study on the safety of health information technology found only anecdotal evidence of these types of problems, but it made recommendations for regulating the development of medical software and monitoring its safe use. Patients can help by keeping tabs on their own electronic data and quizzing their providers if something seems wrong.

Protecting privacy. Though some may worry about the security of patient portals, experts say accessing your health information online is no more risky than using online banking. In 2009, the Department of Health and Human Services started requiring providers to report all potential privacy breaches of personal health information, whether accidental or deliberate. Since then over 57,000 have been reported, of which more than 400 affected 500 individuals or more. (The largest one so far, a theft of data tapes from a contractor for the Defense Department's healthcare system, involved almost 5 million patient records.) However, only about 7 percent of the major breaches were attributed to online break-ins. Almost half resulted from stolen laptops, computers, and other electronic devices. Paper records represented roughly one in four major breaches.

Patients also bear some responsibility to protect their privacy, says Lygeia Ricciardi, acting director of the Office of Consumer eHealth, which is part of HHS. She learned this herself recently when she applied for life insurance and her broker asked for details about the recent birth of her child—which she hadn't mentioned. She asked where he was getting his information and he said, "You're on Twitter."

"I realized I had made some reference to getting back from maternity leave," she says, noting that, like most people, she has learned to be more careful about what she puts on social media.

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