How e-health records improve healthcare: A cancer patient's story

Going paperless helped Pam Crum deal with medical bureaucracy

Pam Crum was 22 weeks pregnant in October 2004 when she noticed a red rash on one breast. Her doctor thought it was simply an inflammation that sometimes occurs in lactating mothers. Over a couple of weeks, the rash worsened. Then a lump formed.

Crum was sent to a breast surgeon for a more thorough examination, and a month later she got the diagnosis: stage 3 inflammatory breast cancer.

"I was just really shocked, because all along I had been thinking it was probably some odd issue related to the pregnancy," she recalled recently. "I remember thinking, 'I have to really focus on beating this illness because I have two daughters.' I knew my three-and-a-half-year-old daughter would be devastated. And, we were already so attached to the [unborn] baby, we just couldn't imagine something happening to her. I thought, 'I just take this day by day.' "

During her journey through treatment, Crum's health care providers at Georgetown University Hospital used the industry standard at the time, paper-based medical records. But along with a large segment of the healthcare industry over the past two years, the University transitioned to using electronic health records (EHRs).

Crum transitioned as well.

She went from filling out repetitive forms for multiple physicians and specialists and being her own courier of radiological films, to having doctors sit beside her with laptops already populated with all of her latest medical information and images.

The U.S. government is pressing all medical facilities to roll out EHRs by 2016, but the going has been slow so far. By the end of next year, 58% of small physician practices are expected to have EHR systems in place. And by 2014, the federal government wants more than half of all healthcare facilities to use EHRs.

Facilities that roll out EHRs -- and prove their meaningful use, according to federal standards -- can receive tens of thousands of dollars in reimbursement money under the American Recovery and Reinvestment Act of 2009. Some facilities, depending on their size, could get millions.

EHRs are also expected to promote the use of evidence-based medicine, or the use of standardized medical practices.

But, there has been pushback from physicians who at times feel a bit like data entry clerks as they must log into order-entry systems to order scans, treatments and medicines and also write up their own notes. The alternative to EHRs: paper records.

The paper chase

Crum lives in Chantilly in northern Virginia. Her insurance company required her to have in-state mammograms and MRIs, which meant she had to pick up the films and take them to Georgetown, 40 miles away in northwest Washington, D.C. Because her medication could also affect bone density, she also had to have bone scans, which also had to take place in Virginia.

If not for the willingness of her primary care physician to fax his referrals, Crum would have also had to carry those documents to each specialist she saw.

A familiar scene for Crum whenever she got to Georgetown for her checkups and chemotherapy was the crowd of other patients carrying the obligatory "huge medical folders."

And then there were the forms.

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