By ALAN BAVLEY

The Kansas City Star

Mark Plautz commands his patients’ care with just a few clicks of a computer mouse.

Plautz, a critical-care specialist, can pull up his patients’ complete medical files from computer terminals throughout the Kansas City VA Medical Center, where he works. He can order tests, look at X-rays, make referrals.

All without putting pen to paper. “Instead of my illegible handwriting, I can order a prescription from here,” Plautz said.

Doctors and patients of America, this is your future.

The world of health care, high-tech in so many ways, is one of the last bastions of paperwork — files and orders written by hand, stuffed into folders and stored on shelves.

That’s all about to change. Tucked into the federal stimulus package is $19 billion to computerize the nation’s health care system.

The goal: For every hospital and doctor’s office to do what the Department of Veterans Affairs has been doing successfully for years — put patients’ records into computer files and share them electronically when patients visit other doctors and hospitals.

The White House wants electronic records available for every patient by 2014.

If all goes as planned — which some question — this digital revolution will make patients safer, help doctors practice better medicine, and save money by boosting efficiency. “It’s a historic investment,” said David Blumenthal, the newly appointed national coordinator for health information technology, who will oversee the drive to computerize. “We’re convinced that it’s possible.”

Medicare and Medicaid will use stimulus money to pay doctors and hospitals incentives to make the change.

Doctors who start by 2011 will collect $44,000, enough money to set up a system in the average office. Hospitals will get a one-time, $2 million bonus, plus higher Medicare or Medicaid payments.

By 2015, incentives will turn into penalties for those who lag behind.

Kansas City area doctors and hospitals could receive between $200 million and $300 million in stimulus money.

The federal government is still working out regulations to ensure patients’ privacy and technical standards so that different computer systems can “talk” to each other.

Challenges await

The rules are due by the end of the year. Meeting that deadline won’t be easy.

“It will be a big test of the federal government’s ability to deliver on the charge we have been given by Congress,” Blumenthal said.

Some doctors and conservative critics see electronic systems as an intrusion into medical practices that could take decisions out of doctors’ hands.

And some fret that the records will jeopardize privacy and that computer glitches could put patients at risk.

Potential risks are so great that the computer systems should get the same rigorous testing demanded of new drugs, said Sharona Hoffman, a Case Western Reserve University law professor.

Last year a glitch in the VA system affected nearly a third of its hospitals. Although no patients were harmed, the VA reported nine cases in which patients received incorrect drug doses.

But ideally, proponents of electronic medical records say, the system will work with the same seamless security as the networks of ATMs that allow customers of one bank to draw cash from machines operated by other banks.

Electronic medical records offer many opportunities to improve health care:

· Safety: No more medication mix-ups from garbled prescriptions. Alerts about drug interactions and allergies flash on the computer screen.

· Quality: As doctors examine patients, computer prompts recommend appropriate tests or treatments. When patients show up at the emergency room, their records will be available instantly online.

· Savings: No need to reorder tests or scans because the paperwork is missing.

Most researchers who have looked at whether electronic medical records can improve health care generally give automation good marks.

A recent study of urban hospitals in Texas found that the more advanced their computer systems, the lower were their death rates, complications and costs for some conditions.

For example, at hospitals where doctors had the most sophisticated software to help them make decisions about patient care, the average heart bypass cost $1,000 less.

“I can’t imagine not having electronic medical records,” said Plautz of the VA.

When Plautz sees a patient, he logs on to a computer in the exam room and calls up the record. On the screen, he gets a series of pages organized like a binder with tabs at the bottom.

The first page is a “cover sheet” with a list of the patient’s medical problems, allergies and current prescriptions. There are reminders to the doctor — if the patient needs a flu shot, for example, or should be prescribed certain drugs.

From there, Plautz can click tabs to pages for ordering tests, prescribing drugs or entering notes about the exam.

The VA’s decade-old system links all its hospitals and clinics.

Other health systems that have adopted electronic medical records also have been pleased with the results.

Group Health Cooperative, an HMO with 600,000 patients in Washington state and Idaho, maintains electronic records that patients can access from their home computers. They can review their lab results, order prescription refills and e-mail questions to their doctors.

“We’ve had huge usage,” said Gwendolyn O’Keefe, Group Health’s medical director for informatics. “It provides patient satisfaction and patients don’t abuse it. They respect physicians’ time.”

Although it is far from certain that all systems will work that way, Google and Microsoft have launched online services where people can store their medical information.

So far, only about 17 percent of doctors and 9 percent of hospitals have even basic electronic records systems.

“It’s costly, it’s complex, it’s transformational,” said Deborah Gash, chief information officer for the St. Luke’s Health System, which has been investing millions of dollars in the technology to go digital.

“Without an incentive to do it, people may be reluctant to take that step,” she said.

Many are waiting to find out which computer systems will qualify for federal incentive payments, Gash said.

But locally, early adopters are pioneering electronic records.

Two dozen Kansas City area employers and hospital systems sponsor a nonprofit network called CareEntrust that maintains electronic medical records on their employees.

Above article published on http://www.kansascity.com/105/story/1172352.html