Jim Schibanoff, Editor-in-Chief of Milliman Care Guidelines; Ron Sims, King County Executive; and Mike Kreidler, Washington State Insurance Commissioner, give their final thoughts at Healthcare Town Hall.
Q: We just have a few minutes left. I’d like to use them to ask you to think for a moment: Is there anything here that you think is important to say about electronic health records that didn’t get said or any final thought you’d like to leave our audience with here in the hall and on TVW?
Jim Schibanoff: Well, I don’t think we’ve touched on the research potential of the electronic health record databases. At huge institutions like Kaiser and the VA, they use EHR as a research tool to look for things like complications of drugs. The best example is, there was this new pain medicine, COX-2, C-O-X 2, that replaced a pain medicine that caused intestinal bleeding. So these COX-2 inhibitors were the great development in pain relief. At Kaiser, they found that, with their very large databases, they found that COX-2 inhibitors caused heart attacks, and most of them were taken off the market. And it was through the power of these very large databases that they became a tremendous research tool, and I think this whole field holds great promise for our research frontier.
Jim Schibanoff of the Milliman Care Guidelines, Scott Armstrong of Group Health, John Hammarlund of CMS, and Joe Scherger of Lumetra discuss physician adoption of electronic health records.
Q: Jim Schibanoff, we’ve talked a bit about the cost and investment requirements of adopting these systems. I’m curious also about the impact on providers of learning these new systems, learning how to use them effectively. Is this potentially a larger burden for healthcare providers?
Jim Schibanoff: Well, it’s great to hear Scott describe Group Health’s experience, the after, because most physicians are dealing with the before, which they see as great disruptions to their routines of care, more inefficiencies in their practices. They feel under financial pressure already and here it’s taking more time to use this electronic health record. So getting over that hump is a significant issue. And in systems like the VA, Kaiser, I believe Group Health, there is much more of a group culture. There’s a financial mechanism, a delivery mechanism. The physicians are more integrated into the system, as opposed to all the physicians in private practice who are in one or two physician offices and may go to one or two hospitals.
Q: Gail Graham, in the case of the V.A., who owns the patient records in your system?
Gail Graham: Well, by statute, V.A., as the custodian of the record. But the information is actually owned by the patient, and the control and the release of that information is owned by the patient. We do have legal parameters for how we keep it and the duration for which we keep it. But disclosures of that information are established in the Privacy Act and in HIPAA. And I think for us, too, our patients have a long history of maintaining a copy of their record that dates back to their military service. So even before provisions of HIPAA allowed for amendment and getting copies of your records, it was a very commonplace thing for the veterans to keep a copy of their medical record as they moved around.
Q: What have early adopters of electronic health records experienced? What key factors determine their success?
Jim Schibanoff: There’s a combination of what’s actually occurred, what medical evidence shows about what electronic health records do to improve care, and then what is the promise. We tend to hear more about the promise of the future than what has actually been proven to be effective. The thing that has been proven to be effective is in the hospital setting where physicians use the computer to write orders that are legible, cannot be mistaken in the decimal point, or the number can’t be mistaken. Medication errors are drastically reduced, and the turnaround time from the time that the order is written until the medication is delivered to the patient is markedly reduced. That we’re agreed upon.
Everything else is a hope and an expectation depending upon factors that we’ve already heard. Just putting computers into a broken healthcare system makes it faster—and broken. You need to improve the healthcare system as you make it electronic. You can’t have one without the other.
George Scriban of Microsoft, John Hammarlund of CMS, Dr. Joe Scherger of Lumetra, and Dr. Jim Schibanoff of the Milliman Care Guidelines field the question
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