Computer standards speed physician acceptance

Common terms, good outcomes lure physicians

Recent developments in computer standardization and compatibility, along with evolving standardization in medical terminology, will help erase barriers to physician acceptance of computerized patient records, suggests Clement McDonald, MD, co-director of the Regenstrief Institute for Health Care, professor of medicine at Indiana University, and a physician at Wishard Hospital at the University Medical Center, all in Indianapolis. Quality assurance professionals can hasten physician acceptance by highlighting benefits of computerized record systems and choosing systems based on their compatibility and ability to support standard codes.

Although physicians want the information computerized record systems offer, they don't want to deal with figuring out all the different formats, says McDonald.

"The problem is that the data is being collected in all kinds of different organizations and it is too hard to move it to where the patient's medical record would be," McDonald says. "The way to reduce the problem is [through] standards."

One of several evolving standards that quality managers should be aware of is the Logical Observation Identifier Names and Codes (LOINC), which is supported by several academic institutions and the Regenstrief Institute. This coding system covers more than 98% of standard laboratory tests. The system database is available via the internet at http://dumccss.mc. duke.edu/standards/HL7/termcode/loinclab/.

McDonald, who has been exploring the possibilities of computerized patient records for 20 years, also sees a movement toward standardization of language and terminology which he predicts will heighten physicians' interest in electronic patient records.

J. Michael Fitzmaurice, PhD, director of the Center for Information Technology at Rockville, MD-based Agency for Health Care Policy and Research, agrees. "The biggest barrier [to computerized patient record systems] is human adjustment," he says. If he could change anything about the state of computerized health care systems, he would push for more uniformity in the terms that the clinicians use to describe patients."

Focus on benefits of computer use

Meanwhile, as these barriers erode, quality managers can promote the use of computerized patient records by stressing their benefits to physicians -- namely, timely data and enhanced outcomes management capabilities. "If the physician gets something out of it, if there is an improvement in the care of the patient, if the physician can compare how he or she does compared to colleagues, those are some strong incentives," says Fitzmaurice, who wrote the chapter "Computer-based Patient Records" in the book The Biomedical Engineering Handbook by Joseph D. Bronzino, Ed.

For instance, the data provided by computerized patient record systems can help physicians and hospital administrators determine the effectiveness of developing technology like laparoscopy, he says. With the detailed data as close as a video display terminal, physicians can see mortality rates, infection rates, and how frequently accidents like nicking a bile duct occur with that procedure, Fitzmaurice says.

[Editor's note: For more information on LOINC or other standardized formats, contact the Regenstrief Institute for Health Care, RG-5, 1001 W. 10th St., Indianapolis, IN 46202, voice (317) 630-7070, fax (317) 630-6962, e-mail clem@regen.rf.iupui.edu.] *