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Hospitals consider paper-free records

Doctor and patient.

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TEXT OF STORY

TESS VIGELAND: You go online to buy books, to read the news, even to order pizza. Now, patients at New York Presbyterian may also be able to see the results of their latest blood test. The hospital is the first major institution to offer patients their own digital health records. The program started this week. Sally Herships conducted a check up -- to find out if the new system might ultimately tamp down on healthcare costs.


Sally Herships: Patrice Cohen is wearing sparkly earrings and a low cut v-neck. She looks pretty good. Especially for someone who just had her sternum cracked open. Cohen had open heart surgery just a couple months ago -- serious stuff. But the scar from her operation is smaller then her pile of medical records.

Patrice Cohen: I saw the file one day and I actually had to make a joke, am I really that sick? It's about, you know, eight inches high.

Cohen is 50. She lives in New Jersey. She has some other conditions too. And a lot of doctors.

Cohen: A cardiologist, I have a nephrologist, I have a rheumotologist, and then of course my GP. And of course, I guess, my gynecologist.

The doctors at the hospital where Cohen had her surgery, New York Presbyterian, are trying something new. Instead of paper they're offering digital records. Cohen can now access her files online. She says if the country's whole healthcare system went digital, patients like her wouldn't need to waste their time with duplicate paperwork.

Cohen: You go to a new doctor, you fill out all these new forms. What medication do you take? What allergies do you have? What surgeries have you had? When have you had them?

In the meantime she says her doctors are glad they no longer have to be pen pals. Waiting for reports to be faxed and mailed can cause delays. Instead she says, she logs on to her account and prints out whatever they need. Ashley Katz is executive director of the non-profit organization Patient Privacy Rights. Katz says, while there may be benefits to health information technology, there are risks too.

Ashley Katz: So people can do really good things with that information and then they can do really bad things.

Katz says without strong privacy protections in place employers and insurers may be able to see private data. Say someone is taking medication that's expensive or for an embarrassing condition.

Katz: So say they're taking an anti-depresant or an anti-anxiety medication, or something for a sexually transmitted disease.

Medical information, Katz says, can easily influence what employers and insurers think. A person's abilities and costs can be evaluated, all based on their private medical history. But heart patient Patrice Cohen isn't worried about digital records.

Cohen: One day I went with my whole thick paper file to one of my doctors and I left without it. First of all I had to figure out where I left it.

She got her files back. And now, she says, she feels much safer knowing her hospital records are online. And Cohen says while getting stuck with needles doesn't bother her anymore, getting the same procedure twice does -- it can be expensive. Recently she had an EKG. A couple days later she saw her cardiologist. He also wanted to test her heart.

Cohen: I said oh, I just had one done two days ago. So he said OK, then we don't have to do it. Called the GP's office and that was the day he was off.

Those doctors aren't part of New York Presbyterian's system. Their records aren't online. So she had to do the test -- again. Richard Hillestad is a reseacher at the non-profit Rand Corporation. He agrees digitizing health records will save money. But right now he says, most of those savings will go into the pocket of insurers.

Richard Hillestad: Ultimately you would hope that those savings to insurers would be passed on down to reduce health care costs for individuals.

Hillestad says if it were to go completely digital, the country's health care system could save $80 billion. Patrice Cohen has to have her heart surgery again in 15 years. But she says, in medical science that's light years away. Next time she hopes she'll be able to take a pill instead of having an operation. And she says, by then all of her medical records should be online.

In New York, I'm Sally Herships for Marketplace Money.

Anne BuenaVista's picture
Anne BuenaVista - Apr 13, 2009

I agree that medical records need to be kept electronically to save time, money and lives but how many different medical records software programs will be out there and how can we make sure that all the programs will be compatible with each other? What good is a medical record if it can't be read by another doctor or downloaded or it takes them time to figure out how to work the software? There need to be standards.

John Tobin's picture
John Tobin - Apr 13, 2009

Without a doubt, one of the advantages of an electronic medical record is the possibility that information can be readily accessible to the person most affected by it - the patient. It can also be, as pointed out in the story, a more efficient and reliable way of dealing with an overwhelming amount of information. The EMR is touted as reducing errors; less is said of the errors it introduces, not the least of which is that the provider interacts more with a keyboard and CRT than with the patient. As a teacher of medicine in an institution that has adopted one of the EMR systems currently available, I am very concerned that trainees are getting the impression that "blowing" enormous amounts of data into a progress note constitutes an "evidence-based" approach, and thus fail to address the human needs of the patients they see.

Anonyms Wasawoman's picture
Anonyms Wasawoman - Apr 12, 2009

I appreciated this story however a few notes. I worked on designing some of the very first electronic medical records (for EDS, Medicus, and others) and as both a designer/engineer as well as having managed a clinic and ...I used to work for several of the major health insurers (and a startup which competed with them) - so I have some experience with this. From the engineering standpoint, the focus on security is a bit over the top and is largely because those who are in charge of such projects (and who run most clinic administrative operations) are vastly illiterate when it comes to technology. And - if you have people with barely a high school diploma running the front office or doing the bulk of the paper pushing in these offices (some have been at the same job for 25 years and know enough to move a cursor around an outdated screen)... you can sort of get the picture here, eh... Those who are charged with actually designing and developing these systems are often primarily coders and programmers (often called "web developers"). The usability design is done via opinion - opinion of the programmer or opinion of a committee of administrators vs. actual usability engineering standards and practices. The research used to develop these applications is usually a marketing survey (vs. actual usability and cognitive testing). This leads to the difficulties of wading through many an electronic medical record now on line and then to the myriad of complaints often coming from health practitioners such as MDs and nurses. I will never understand, to this day, though that if I as a patient have given written permission for an office to email me (which I did several years ago) my MRIs (which have been stored digitally and available to health practitioners vs. patients for many years now - they can be put into .jpg form very easily), why we have had to wait (and are still waiting) until now and for some big system to get this going. Last words, when we finally get down to it and just simply get rid of the unnecessary private insurance middle-"man" altogether from health care, the "pipeline" will get cleared up and the savings will indeed start to go back into the economy and to where it should go, patients and doctors. This week, by the way, in California - health care reform gets its first big hearing: SB810. Wednesday is the day... you might be able to learn more at singlepayercentral.com

Rob Lightner's picture
Rob Lightner - Apr 12, 2009

NY Presbyterian using Microsoft HealthVault is a big first step toward better management of - and patient control over - health records.

But we don't have to wait for our providers to step up, as anyone can start an account with HealthVault and share it with their doctor. With pressure coming from the feds to shift to electronic records, it wouldn't hurt to add a little extra pressure from the other side.

Linda Pilgrim's picture
Linda Pilgrim - Apr 12, 2009

I have been accessing my medical records online at Beth Israel Medical Center since I moved to Boston in 2004. I often find out my test results before my doctor has time to look. I can even look up all of my records since then through today, right now.

Craig Lindsay's picture
Craig Lindsay - Apr 11, 2009

How is this different from what Mid-Atlantic Kaiser does?

As far as I know all of our records have been electronic from more than a year.

I can see my tests etc and easily see how I'm doing. Doctors other than my primary physican can access my records bring up various pictures, etc.

Richard Alberta's picture
Richard Alberta - Apr 11, 2009

Regarding: Hospitals consider paper-free records.
Mrs. Herships, if I, a white male, had described the patient in your story as "looking pretty good with sparkly earrings and a low cut v-neck" I would have experienced the full force of 40 years of feminist-needle-toothed-orally-aggressive-political-correctness ripping away at my flesh. You'd better read NPR Comment Guidelines regarding prejudicial, harassing commentary the infringes upon others enjoyment of radio. Richard Alberta