Obama's national health records system will be costly, daunting

But an electronic health records system could save the nation $300B a year

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In addition to legislating EHRs, Bigby said the e-Health initiative is now developing payment models that would reward physicians who show they are using the state's disease registries or other types of electronic medical support tools to care for patients.

Cutting costs

Fallon rolled out EHR systems at 23 of its facilities using e-health record management software from Epic Systems Corp. Not including the vendor search and contracts, the project took three years and completely changed the way doctors and nurses performed administrative duties, Garber said. For example, no longer are prescription pads necessary; all drugs are ordered through an electronic network. Fallon also rolled out Dragon voice recognition technology from Nuance Communications Inc.

Fallon saw immediate ROI. It was able to cut 70 positions dedicated to moving or filing paperwork. It also stopped sending physician voice notes to overseas transcriptionists, a system that cost $10,000 per doctor a year.

"Electronic medical records gut your organization, and everything you do will be different after it," Garber said.

Although the Bush administration awarded contracts to private corporations to develop a National Health Information Network, RHIOs are likely to remain at the community level to keep things simple, Garber said.

Bigby disagreed, however, saying Massachusetts plans to establish a statewide RHIO because that will be critical to tracking health trends statewide as well as identifying wasteful practices.

"While it is true that probably 85% or 90% of care happens within the community, there is a benefit to having a state-level heath information exchange," she said, noting that the state will look into using online services, like those offered by Google Inc. and Microsoft Corp.

Microsoft launched its HealthVault beta program in 2007 and has now partnered with Kaiser Permanente and the American Heart Association, among others, to create a database accessible by patients and authorized care providers. Earlier this year, Google launched its own health records beta, Google Health.

Another health care operation looking at those same online services is Riverside Health System, according to Frazier. Riverside includes five hospitals, three cancer treatment centers, two long-term care centers, private care practices and retirement communities, and relies on myriad medical record systems that do not mesh, including systems from General Electric and Siemens Medical Solutions.

One big frustration for the 300-plus physician group practice: the lack of advance notice from hospital emergency departments that had seen patients.

Riverside needed a way to automatically log patients out of its emergency department to provide caregivers accurate, up-to-date information. Previously, someone in the medical records department would spend eight hours a day updating the registration system to log out patients. That information would then be manually transferred to a primary care physician's office. "Using Boston WorkStation against our Siemens Invision system, we can now log these patients out in less than one hour. The script took us only three hours to write. The result is not only a more efficient registration process in the emergency department, but also [freed up] a full-time employee to use in a more substantial capacity," said Jim Foss, director of IS physician services.

Physicians can get updated patient information daily from the emergency department. That, in turn, improves the safety and quality of care for patients and provides medical staff immediate access to critical patient information. Ultimately, Boston Software Systems' Boston WorkStation allows clinical information to flow easily throughout a patient's continuum of care.

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