Universal Electronic Health Records: Progress or Boondoggle?

Flagler Hospital of St. Petersburg, FL, for one, replaced patient charts with mobile laptops, computers on wheels (COWs, although the name might offend overweight patients), that allowed doctors in 30 specialties to chart at the bedside using one software program. An unintended consequence, though, was that doctors had to keep two sets of medical records, one in the hospital and the other in their offices, because the hospital EHR couldn’t talk to the office practice EHR. So they still have to fax patient records, test results, and images between hospitals and physician offices.

Children’s National Medical Center in Washington, DC, solved that problem by selling site licenses to its physician groups for $6000 per computer, versus the retail cost of $20,000. Giving physicians incentives to use a shared hospital-physician group EHR has made lab results immediately available, and enabled doctors to read consultants’ comments on their patients. This has strengthened the link between the hospital and its attending doctors.

For Jerry Luck, Director of Facilities System Administration for West Virginia’s Department of Health and Human Services, the bargain-basement price tag of $9 million for an EHR implementation for West Virginia’s eight state-owned hospitals and nursing homes compared favorably to the $90 million spent by the West Virginia University Hospital system. He started looking for a new electronic medical record system in 2005 because the old system, with proprietary software and lots of consulting dollars spent to keep it going, was going to be discontinued.

With one IT person in each facility, the organization needed a system that would provide all necessary functionalities but be cost-effective and easy to maintain. Mr. Luck opted for a system based on the Veterans Affairs’ well-established VistA EHR, an open source software with more than 20 years of field testing and refinement. VistA contained 2.1 billion documents, 2.76 billion orders, and 1.51 billion images, making it most unlikely to disappear. He chose Medsphere’s Open Vista as the platform for the EHR for his system’s eight facilities. We saw demos of the EHR at the VA hospital, so we knew its modules and functionalities addressed all of our needs. That included all the vital sign recording, tests, diagnostics, prescriptions, and physician notes, he said. There are no more paper notes. Physicians and other providers use laptops or COWs, except at the psychiatric facilities, where the COWs could be used as weapons.

Because the VistA EHR was implemented throughout all of the West Virginia Department of Health’s facilities, physicians didn’t have a paper chart option anymore. Everything had to be on the computer system, and the doctors had to do their own data entry. It was hard for some of the older docs who didn’t grow up using computers, but some medical students who had been at the VA and were very familiar with the system sold it to the laggards. Also, when they realized they could access patient vitals while relaxing in the physicians’ lounge, they got to like it, said Mr. Luck. Although all the facilities are connected, HIPAA and privacy concerns meant that access to each patient’s record must be guarded. He explained, That was no problem. We set up one database, then partitioned it out. So, for example, if the patient is moved from the hospital to a long-term care facility, each facility allows access to the record only once the patient is admitted.