Paperless records will improve quality

Predicted to be standard of care in 5 years

Paperless records will have a tremendous impact on health care quality and physician efficiency, according to an expert who says they will become the standard of care within five years. Act now to take advantage of the coming revolution, he says.

Jerome Carter, MD, FACP, is director of informatics at the University of Alabama-Birmingham and an expert on the topic of electronic records. He tells Hospital Peer Review that, after years of talk, the move to paperless records is picking up steam. The next five years will see a rapid adoption of the technology, he predicts, and that’s good news for health care quality.

The recent emphasis on reducing medical errors and the Institute of Medicine’s report To Err is Human all point to the need for improvement over the traditional paper record system, Carter says.

Electronic records greatly improve the clinical staff’s ability to provide better care and avoid systemic errors, he says. Many of the benefits come from the electronic record’s greater capabilities for spotting trends and clinical interventions that have not been utilized.

"Along with improved screening and monitoring of known useful preventive interventions, avoidance of medication-related errors is likely to be the next area of health care to see a significant impact," he says. "All electronic medical records [EMR] systems provide features that support drug interaction checking, prescription writing, and drug-related patient education. As greater numbers of clinicians gain access to these features, it is very likely that patients will benefit in a very obvious and direct manner."

The Leapfrog Group, a Washington, DC-based consortium of health care buyers who have banded together to leverage improvements in health care safety, is promoting the adoption of electronic records because of their potential for improving quality. The Health Insurance Portability and Accountability Act (HIPAA) also emphasizes the need for a paperless record.

"Given the rise of HIPAA, the recent emphasis on medical errors and patient safety, and the acknowledgment that EMRs provide the most means for addressing these issues, I expect that electronic medical records will be the standard of care within four to five years," Carter says.

"All of these things are forcing physicians and quality professionals to look at the way they do these everyday processes of care. The only way to improve these processes in a reasonable amount of time is a paperless record," he adds.

Discussions of electronic records often focus on the patient-encounter note, but Carter says that is the least promising aspect of paperless record systems. The encounter note usually is used only by the physician who wrote it, but a good electronic records system can make information available to both that physician and the rest of the staff that they otherwise might not have.

"The preventive medicine capabilities can tell the system to spot all women over 50 who need a mammogram, or it can do a drug recall by finding all the patients taking that drug. You can set up the system to prompt interventions based on certain inputs," he says.

"The system can provide information that significantly adds to the quality of care, rather than just being a different way to store data. It’s going to be difficult in five years to say why you’re not doing that when you know the capabilities," Carter explains.

One paperless communication system is being tested by the Patient Safety Institute (PSI), a nonprofit, voluntary, collaborative initiative in Washington, DC, formed to establish a technology-based patient safety and health care information solution. PSI has selected hospital sites based on their community leadership and patient-centric focus to demonstrate a communications network the group devised to improve patient care.

The PSI system, which will provide real-time, secure, patient-centric clinical information access to participating physicians, was installed recently at Deaconess Medical Center and Valley Hospital and Medial Center in Spokane, WA; and Swedish First Hill, Swedish Providence, and Swedish Ballard, in Seattle. Jack Lewin, MD, CEO of the California Medical Association and chair of PSI’s board of directors, says the system is intended to improve patient safety by providing clinicians with more and better information.

"Both hospital systems selected are ahead of the learning curve in terms of patient-centric technology," he says.

"The PSI demonstration program has received outstanding support from both hospital systems. Their in-depth expertise and input will help ensure the PSI network is optimally structured to achieve our goal of improved health care safety and quality nationwide," Lewin adds.

Suzanne Delbanco, executive director of The Leapfrog Group, endorses the idea of preventing errors through better use of electronic records.

Emphasizing quality improvement rewards

"Preventing medical mistakes involves improved communications between patients, physicians, providers, and purchasers," Delbanco says. "PSI’s breakthrough real-time clinical information service, coupled with the computerized physician order-entry systems Leapfrog promotes, will further reduce the risk of errors."

Peer review professionals can spearhead the adoption of electronic records in a health care organization by showing the effects on quality improvement. The biggest impediment to rapid adoption of the electronic record is the lack of reliable information on different electronic systems, Carter says.

There still is not a reliable source of information for comparing products from different vendors, so Carter cautions that you have to take a chance now when you buy a paperless records system.

"The cost of the actual software is not that great, and the cost of the hardware is not an issue whatsoever. Even hand-held units are extremely affordable," he says. "It’s also very hard to find a good consultant to make these decisions for you, because most of them are resellers associated with vendors. The infrastructure for making this change is not there yet."

Other than pushing for the adoption of an electronic records system, Carter says quality improvement professionals should use their expertise to help select a paperless record system that will be most useful in improving quality of care. That means focusing on features like referral management, prescription management, monitoring of lab results, and preventive medicine systems.

"Going paperless is not the issue," Carter says. "That’s just the way you’re doing it. Getting more information about your patients and managing their care better is your goal."

[For more information, contact:

  • Jerome H. Carter, MD, FACP, Director of Informatics, 1917 Patient Care and Research Clinic, Division of Infectious Diseases, Department of Medicine, University of Alabama-Birmingham, CCB178, 908 20th St. S., Birmingham, AL 35294. Telephone: (205) 975-4386. E-mail:
  • Jack Lewin, MD, CEO, California Medical Association, 221 Main St., 3rd Floor, San Francisco, CA 94105. Telephone: (415) 541-0900.
  • Suzanne Delbanco, The Leapfrog Group, 1801 K St., N.W., Suite 701-L Washington, DC 20006. Telephone: (202) 292-6713. E-mail: info@leapfrog]