Medical Paper Trail Ending With Emergence Of EMR's

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(Sacramento, CA)
Monday, November 13, 2006

Dr. Tom Tinstman’s office sits in the heart of Sacramento’s UC Davis Medical Center.  Everything inside reflects the multi-million dollar medical record conversion project he’s heading up, from the charts on his wall to the picture sitting on his conference table.

“The person in the photo is standing next to a pile that is 8 ½ feet tall…  and that’s the amount of loose filing that medical records receives everyday that needs to be place in a specific person’s medical record.”

Those records fill more than 94,000 linear feet of shelving, and the number continues to grow. Over the next few years, the records of patients in the UC Davis Health System will be converted from paper to digital.   Electronic Medical Records, or EMR's, only require hard drive space and can be accessed on an internal network.  The Health System’s regional clinics already use electronic records. 

Seated in front of an exam room monitor at the clinic in Davis, Dr. Steve Oliver shows how the system works.

“This is the secure entrance into the electronic medical record (typing sound) the record is accessed only by password”

He opens the records of a sample patient and layers of documents appear on his screen.  They detail past medical history, problems and allergies.

“In an old paper record this could have easily been lost in the depth of the record where we would have had a hard time finding it.”

Oliver can use the system to write prescriptions, or order lab tests and x-rays then later view the results in his patient’s chart.   The software also has a reference section where he can read up on conditions or find out whether an insurance company covers certain medications. 

“I think we can provide better medical care because we have all the information at our fingertips.”

It’s that fingertip accessibility that worries privacy advocates.  Pam Dixon heads the San Diego based World Privacy Forum.   The non-profit group researches areas where technology and privacy overlap.   Dixon believes what EMRs give hospitals in efficiency, is taken away from patients in privacy.

“Someone within the healthcare system who has access can use the information inappropriately and usually when it’s used inappropriately it is for medical identity theft  ..It’s much easier to carry out a stack of a million files in a hard drive than a million paper files.”

In a recent report on medical identity theft, the World Privacy Forum estimates there are a quarter to a half million victims across the nation.  Dixon worked with one victim whose stolen medical information was used to obtain two surgeries. 

“When he went to the hospital, the hospital did not have the appropriate information, different blood type, different diseases, different history of surgeries: it was just a mess, and under the law its very, very hard to get incorrect information taken out of your medical file.” 

The victim got stuck with $44,000 in medical bills and the debt eventually went on his credit report.   When hospitals put EMR access on the internet, Dixon says privacy becomes an even greater concern.  On call doctors can already log into the UC Davis system from home and in the future, patients will have limited online access. 

“I’m not saying digital or electronic is bad… I think what’s really important is that we do it in an intelligent way and that we do it with security in mind.”

At the clinic in Davis, Dr. Oliver feels confident in the safety of patient information.  The password-protected system keeps track of who logs into a patient’s record, where and when.  And there are different levels of access with doctors allowed to see more information than, for example, a receptionist.   Oliver believes EMRs actually improve patient privacy. 

“We don’t have stacks of charts laying out on doctor’s desk or nurses stations where anyone who’s walking by can either intentionally or inadvertently see some of the information there.”

For project head Dr. Tinstman, one of the greatest benefits of EMRs is doctor accessibility.   He recounts a personal experience when his wife came down with a severe case of hives.  She web messaged her doctor for a next day appointment.

“It was 11 o’clock at night, he happened to be looking at his messages and picked up the phone and called and said, I think we ought to start you on treatment tonight and used the electronic medical record to send a prescription to Walgreens that was open 24 hours a day.”

Both privacy advocates and hospital officials can agree on one thing, there’s no stopping the conversion to Electronic Medical Records.  Along with the U-C Davis Health System, other Sacramento area hospitals like Mercy and Sutter Roseville are making the switch.