Setting records straight 

Missoula hospitals enter the electronic age

In 2004 President George W. Bush announced the ambitious goal of ensuring that most Americans have electronic health records by 2014. In his State of the Union speech last week, Bush reiterated that objective: “We will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors.”

But even as Bush was busy preparing to deliver his annual address to the nation, investigators in Clackamas County, Ore., were busy trying to figure out what had happened to more than 360,000 such records that had gone missing.

According to The Oregonian, the confidential medical records of some 365,000 Providence Health System (PHS) patients in Washington and Oregon were stolen from an employee’s minivan on Dec. 31 in Milwaukie, Ore., though PHS officials waited until Jan. 25 to notify the patients that their records had been stolen. According to PHS, the records were stored on computer disks and digital tapes that a PHS information systems analyst took home. The thief broke a window to gain access to the records.

News of the theft has angered privacy advocates, legal authorities and patients. The news also raised questions about how electronic medical records (EMRs) are being handled in Montana, given that Seattle-based PHS merged with Spokane-based Providence Services (which oversees operations of St. Patrick Hospital and Health Sciences Center in Missoula, Benefis Healthcare in Great Falls and St. Joseph Medical Center in Polson) last month.

According to Ray Rogers, chief development officer at the National Center for Health Care Informatics (NCHCI) in Butte, about 9 percent of the state’s physician practices are currently using EMRs.

“That’s not far off from what we’re seeing nationally,” Rogers says. “The larger the group practices are, the more likely they are to be working on an electronic medical record system.”

Rogers says NCHCI’s goal is to develop a regional health-care information system for the state so that all Montana hospitals and physicians are using compatible EMR systems. The idea is that if a patient from Missoula gets sick or injured in, say, Billings, clinicians there could have instant electronic access to that patient’s medical records.

“There’s already a lot of work going on in making these systems interoperable,” says Rogers.

Both of Missoula’s hospitals have already begun to develop such systems, which they hope will streamline patient care, improve treatment methods, and reduce the number of medical errors.

“Medical errors are the third or fourth leading cause of death in the country,” says Lisa Lackner, emergency room director for Community Medical Center.

Last year Community invested more than a half a million dollars in a state-of-the-art computer information system, called the Ibex PulseCheck, to help document, assess and chart patient visits. When the new system went online Dec. 13, more than 100 clinicians at Community’s ER changed the way they do their jobs.

“I’ve been an ER nurse for 29 years, and I know things, historically, fall through cracks in an ER department, because you can’t remember everything about every patient,” says Lackner. “What we’re trying to do is reduce the chance of medical errors. It boils down to patient safety.”

Community’s crosstown counterpart, St. Patrick Hospital and Health Science Center, has spent the last six years and millions of dollars developing a network to connect affiliated hospitals and physicians. Arek Shennar, St. Pat’s information services director, says the hospital is increasingly using EMRs, but a day when all patient records are stored in a digital format is still years away.

“Most of the institutions that are our size or larger have started creating EMRs,” says Shennar. “I’m not sure if there is ever going to be a time that we can say we’re all EMR and it’s done, because it’s an evolving process.”

Unlike Community, where all ER staff members are required to chart patients electronically, St. Pat’s is slowly transitioning from traditional paper records to EMRs.

“Some doctors use it, some don’t,” says Shennar. “It is an education process and a transition process.”

There are multiple technological and security challenges to overcome before Montana hospitals will meet the president’s goal of EMRs for all by 2014.

“Of paramount concern is the security of a patient’s EMRs,” Rogers says. “You have to have a high level of security built into these systems, and there have to be standards of interoperability.”

In other words, information systems at St. Pat’s have to be able to communicate with systems at Community, and they have to do it securely.

Already, St. Pat’s has the hardware infrastructure and security systems in place that allow affiliated hospitals in Polson and Thompson Falls to access its private network.

“For those physicians that have access and the appropriate security and passwords, they can sign on to our network and look at patient information as if they were in-house,” says Shennar.

Officials at Community and St. Pat’s insist that the large-scale theft of patient records, as happened in Oregon last month, would be nearly impossible here. Both hospitals have redundant backup systems that save patient records and information in secure locations, and no backup tapes or disks ever leave the hospital campuses.

“Doctors are very adamant about the security of EMRs,” says Rogers. “The reality is, it would be easier for you to break into an office and steal paper records than it would be to access electronic health records.”

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