Getting With The Program
After a slow start, information technology is making its presence felt in healthcare – to the benefit of patients and doctors.
In Savannah, a 60-year-old man goes to his laptop instead of the phone to schedule his annual physical. While online, he double-checks last year’s lab results and requests a refill of one of his prescriptions.
In Rome, a breast cancer patient makes travel plans for the first time since her diagnosis, assured that she can have access to her medical records as well as the ability to communicate with her doctor’s office wherever she goes. In rural Ware County, a third-grader with a sore throat is seen by a pediatrician – who is almost 250 miles away in Atlanta.
These scenarios and more are possible thanks to the rapidly growing field of health information technology (HIT), defined simply as the exchange of health information in the electronic environment. This encompasses the secure exchange of information between consumers and providers of all types (including physicians, dentists and pharmacists) and insurers, both private and public, as well as government entities and organizations.
While information technology in healthcare has lagged well behind banking and other industries (consider the introduction of ATMs in 1969 and online banking in the ’80s), it is steadily gaining ground, says Wade Fletcher, M.D., an internal medicine physician at Memorial Health Medical Center in Savannah, which was named by U.S. News & World Report as a leader in the development and use of electronic medical records technology, the cornerstone of health IT.
“When we look at healthcare, obviously it is a bit behind other industries in embracing IT,” he says. “When you look at how long banking has had computer systems, healthcare is playing catch up.”
Experts cite a number of reasons for the delay. Understand-ably, they say, expenditures for technology in healthcare have focused largely on advances in treatment – new medicines, robotic surgery, drug-coated stents, for example – rather than advances in communication. Until recently, technology that would allow the sharing of medical data – which unlike financial data is not just numeric, but alphanumeric and narrative – was lacking. Another reason was the reluctance of the medical community itself – physicians are slow to change without good evidence-based data, says Dr. Fletcher.
The growth of health IT in recent years is largely due to federal mandates for the adoption of electronic medical records technology (the complete transfer of traditional paper records to an easily storable, searchable and transferrable electronic format), which could mean financial incentives for providers now and penalties for noncompliance beginning in 2015, as well as a number of initiatives in Georgia, including GeorgiaDirect, a secure email messaging platform that can be used by authorized physicians and other healthcare providers to transmit health information about individuals in the course of their care.
Launched in June 2012, through a partnership of the Georgia Health Information Network (GaHIN) and the Health Information Technology Division of the Georgia Department of Community Health, GeorgiaDirect currently connects more than 2,100 providers in Georgia as well as participating providers in Alabama, Mississippi, Florida, Hawaii and Wisconsin, says Pamela A. Keene, a spokesperson for the Georgia Department of Community Health. “Eventually there will be connectivity for healthcare providers across the nation,” she says. “We anticipate nationwide connection within the next 12 to 18 months.”
Experts say that once fully adopted, health IT will have myriad benefits, including improving healthcare delivery, engaging patients in their own care, reducing healthcare costs and hassles, preventing medical errors and harmful medication interactions, increasing administrative efficiency and expanding the availability of care.
Here are some of the ways health IT is changing and is promising to change the delivery and experience of healthcare in Georgia.
Not long ago, results of labs and other tests were almost always delivered by a postcard though the mail. Although some providers sent results only if they were abnormal and required follow-up, for the patient, no news didn’t necessarily mean good news. Failure to receive a postcard could have meant normal test results, but it also could have meant the postcard got lost in the mail or was misplaced.
Obtaining medical records, too, was sometimes problematic. Getting a copy for your own use often required a per-page fee for photocopying, a wait of days or weeks for a busy staff person to copy the pages and a trip to the doctor’s office to pay for them and pick them up.
Today, with nothing more than a user name, a password and an Internet connection, many patients can gain access to their medical information, says Monica Newton, M.D., a family medicine physician with Northeast Georgia Physicians Group in Gainesville, one of a large and growing group of providers in Georgia who use what is frequently referred to as a patient portal to relay and receive important health information from their patients. Patients can use the portal to schedule appointments, request prescription refills or send a message to their provider, who can use the portal to respond to messages or provide health information.
“What’s key is promoting a sense of patient engagement,” says Dr. Newton, “because patients’ health information is really theirs.” Patients using the portal not only have the opportunity to see current test results but historical information as well, she says. “The patient can go back and pull labs from six months ago and look at what the trend is, without having to go back and ask their doctor if the results are better or worse than previously.”
Evolving technology will make it possible for the portal to share imaging tests such as X-rays and MRIs and other more complicated information – a possibility that concerns some, says Dr. Newton.
“I think there’s always a fear with technology that patients will have more questions than answers, because they don’t understand the complexities of the exam or an MRI or a CT scan,” she says. “As we roll out things we will see how people do, but I tend to fall on the side that the information is the patient’s anyway. I think putting it in the hands of the patient enables us to engage the patient more in their healthcare rather than having a more paternalistic ap-proach.”
Patients needing specialized care in Georgia’s rural counties once had only two options: drive a long distance to see a specialist or do without. Today, technology offers a third, better option: the opportunity to see physicians right where they are through the Georgia Partnership for TeleHealth (GPT).
One of the most robust, comprehensive networks in the nation, GPT has brought the expertise of specialized physicians to nursing homes, school clinics, specialty clinics, emergency departments, ICS and correctional facilities in underserved areas. In rural Ware County, for example, every elementary school has telemedicine capabilities. Students who need to see a pediatrician can go to the school nurse’s office during the day and see one within 15 minutes, says GPTs Chief Operating Officer Jeffrey Kesler, PsyD, in Waycross. Many Ware County teachers have also taken advantage of the schools’ telemedicine capabilities for their own healthcare.
In 2012, GPT reported 75,000 patient encounters, up from just eight in 2006. GPT now has more than 350 locations with more than 200 specialists and healthcare providers, representing more than 40 specialties participating.
In Rome, a pilot project called MyJourney Compass allows breast cancer patients to access their medical information and providers from virtually anywhere. Funded by the Office of the National Coordinator for Health Information Technology and operated through the Georgia Depart-ment of Community Health, the project provides each of its 26 participants with a Nexus 7 tablet that not only helps them access their health records and communicate with providers, but is also loaded with credible, vetted and evidence-based educational infor-mation that they can turn to with confidence, as well as an app developed at Georgia Tech that enables them to track and better understand their symptoms, says Phil Lamson, a healthcare consultant with Georgia Tech’s Enterprise Innovation Institute.
As anyone who has had a few medical appointments can attest, filling out forms for every new doctor and every new visit is not only a hassle but often a test of memory.
With electronic records, however, each piece of information is entered only once and then available to any doctor who has access to that record. This eliminates duplicate forms and often eliminates duplicate testing by doctors, who have access to results of tests already performed.
The electronic record allows the doctor to get all of the needed medical information about a patient – allergies, immunizations, past illnesses and hospitalizations, medications taken – instead of relying on the patient’s memory, says Kelly Gonzalez, chief of the Division of Health IT with the Georgia Department of Community Health and the Georgia state health IT coordinator. “Having that kind of validated information enables the doctor to provide better care for me versus having them ask me what medications I am on and I say, ‘It starts with a “v,” but I don’t really remember.’ The ability to access accurate medical information is an important capability for providers to have.”
In the ER or inpatient setting, electronic medical records can speak for patients when they can’t speak for themselves, ensuring the doctor has the information needed to guide the patient’s care.
IT applications can also help doctors avoid medication errors, says James Bailey, M.D., chief medical informatics officer and chief quality officer for the Northeast Georgia Health System. When physicians order treatment through an application called computerized physician or provider order entry, the computer, using information in the person’s electronic record, can alert the doctor of a drug interaction or other potential problems, he says.
While doctors can still prescribe the medication if they deem the risks of not prescribing it would be greater, the alert provides a layer of protection that will inevitably improve patients’ safety, he says.
The Best Treatment
In addition to alerting the physician to information in the patient’s record, information technology can alert physicians to what is not in the medical record – for example, an immunization the patient needs or an overdue mammogram.
“That way if a patient comes in for a cold, I can remind her that she needs to schedule an appointment for her mammogram,” says Dr. Newton.
With an extra click or two, the physician can get information about a population of patients. “I can tell you how many patients I have with diabetes [who] are out of control today, based on their last lab results,” says Dr. Newton. “Let’s say I want to see which ones haven’t been in [for] the past three months. With another couple of clicks I can find out, so I can have my staff call a particular patient to tell her she needs to come in.”
Further, new technology makes it possible for doctors to develop and use what are called evidence-based order sets – or collections of orders for a select group of patients based on best practice guidelines. While there is no such thing as cookie-cutter medicine, there are some instances and conditions – pneumonia, for example – when a certain course of treatment is the best way to treat most people.
At Memorial in Savannah, evidence-based team physicians have spent five years building sets for 125 specific specialties and disease conditions, using a referential source called Zynx to help aggregate the data.
“This really [involved] looking at the things for which there exists a clear evidence basis – which antibiotics to use and which things clearly have a proven best way to do things – and then leveraging the power of the technology to help choose the right way,” says Dr. Fletcher. “We have used the technology, leveraged the technology to support good sound clinical decision making. I think that has resulted in better care, better outcomes; and our outcome data has been showing that.”
“In medicine, all physicians have anecdotes, but it is certainly better where there is data to leverage studies that involved a large group of patients – where you think you have a common disease process or illness,” says Frank Davis, M.D., a trauma surgeon at Memorial Health Medical Center in Savannah. “If we can use the best evidence that is available and deliver that at the time of decision-making, we feel like we can better treat a patient based on experience with a large number of patients with a similar or like condition.”
Despite the benefits health information technology promises, proponents are quick to point out limitations. Even the most sophisticated computer systems and applications cannot take the place of the knowledge, judgment and care of a competent clinician, they say.
“I always tell my residents the computer is dumb – it’s only going to do what it is programmed to do,” says Memorial Health’s Dr. Fletcher. “It doesn’t take the place of human beings and the thought process. It still requires doctors and nurses and our analysts telling it what to do and knowing the treatment guidelines and knowing the evidence and revising the evidence.
“Certainly the software does not solve all of our problems – it does not do the doctoring for us, if you will – but it is a hugely valuable tool in assisting us with management.”
Nor can the computer take the place of the compassion and care of a physician, the need for a real person to deliver bad news to a patient and to be available to discuss disturbing test results and the next steps to take.
For that reason, some information is never posted on a patient portal, says Dr. Davis. “Let’s say you do a biopsy and it comes back positive. That is not something you want your patient to discover online,” he says. “That is something you want to have a sit-down, one-on-one conversation with them about.”
“The computer doesn’t replace the fact that the doctor still has to be the doctor,” says Maggie Gill, president and CEO of Memorial Health. “Conversations still have to happen.”