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Hospitals going paperless

Parkview, Lutheran practices tackling transfer to electronic records


Your doctor’s schedule might fill up extra quickly in coming weeks.

That’s because while patients are fighting flu, some physicians will be wrestling with a new way to document those patients’ visits, using unfamiliar computer software.

The concept of electronic medical records isn’t novel – some local hospitals and doctors’ offices have had them for years.

But numerous medical practices have been acquired in recent years by Lutheran Health Network and Parkview Health. As those health care providers adopt standardized software, some doctors, nurses and support staff are heading back into the classroom to learn how to work with the latest technology.

The advantages of electronic medical records are many: easier access to information, fewer duplicated tests and better coordinated prescriptions. But as local health care providers make the switch, they are also encountering challenges.

One is the need to provide enough training so caregivers and support staff aren’t overwhelmed by the transition from paper to electronic records.

Another is the need to ensure the privacy of patients’ most personal medical information after it’s made available online.

And, last but not least, is the need for the electronic records software that Lutheran and Parkview use – made by two different vendors – to be compatible.

Going digital

It’s no coincidence that Lutheran, Parkview and health care providers across the country are embracing electronic patient records at the same time.

The federal government established the timetable with Congress’ passage of the American Recovery and Reinvestment Act of 2009, which included the so-called HITECH Act.

The Health Information Technology for Economic and Clinical Health Act contains both carrots and sticks to encourage health care providers to convert to digital health records.

The HITECH Act rewards those who invest in government-certified software – and demonstrate they’re using it – by reimbursing medical practices up to $44,000 per doctor. And it will punish those who don’t make the switch by cutting federal payments for services provided to Medicare patients.

The push has created a robust market for vendors, including Fort Wayne-based NoMoreClipboard, which employs about 70.

Jeff Donnell, president, said the local software company’s products can fill in gaps in larger vendors’ systems, including tracking palliative care given to patients at the end of their lives.

Donnell credits local health care providers for helping his company develop its products – now sold nationally and internationally – by giving feedback on what worked well and what didn’t.

Parkview Health and Lutheran Health Network have been on the path to implementing electronic medical records for years.

Lutheran’s efforts started in 1995, former CEO Mike Schatzlein said in a 2010 interview. The network’s physician practices are scheduled to adopt the One Patient, One Chart plan in May or June.

Parkview began tackling the issue in the late 1990s, said Ron Double, Parkview Health’s chief information officer.

The local network’s Allen County hospitals are to fully convert to electronic medical records in February. Parkview-owned hospitals in Huntington, Noble, Whitley and LaGrange counties are to convert in July.

Lending support

About half of Parkview-owned physicians’ practices are now relying solely on electronic medical records – or 150 of 300 doctors. Another large conversion wave is scheduled for April and May. The last Parkview practices to convert will be those in northwest Ohio, Double said. The timeline calls for them to switch late in the year.

Some of the Parkview operations were already using electronic medical records, but they weren’t using the EpicCare software, he said. The new software is designed to be used by caregivers in various settings, including doctors’ offices, hospitals and home.

During the conversions, Parkview physicians’ offices schedule just half of their normal patient load for two weeks to allow doctors, nurses and support staff extra time to wrestle with the new technology until they gain more confidence.

For the third and fourth weeks, the offices are at 75 percent of normal schedules. After that, they return to full patient loads.

Many of the practices have returned to their full patient schedules sooner than required, Double said.

“It’s worked out great,” he said, adding that extensive training paved the way.

Most nurses receive 18 hours of classroom education. Doctors get 10 to 15 hours, depending on their specialties. And support staff spends three to four hours in class. That’s in addition to online tutorials and practice labs that allow workers to become proficient, Double said.

No one is certified to access the live system until after they’ve completed training.

But if you think converting to electronic medical records is a minor bump in the road for older doctors, think again. Dr. Steven Orlow, Lutheran Hospital’s chief medical information officer, calls it “a very big deal” for some.

“This is like learning to drive a car without a steering wheel and sitting on the right side and – I don’t know – with a joystick,” he said. “There are a few (physicians) who are not choosing to go down that road.”

Orlow estimated the number of Lutheran-affiliated doctors who plan to retire rather than tackle the technology is less than 10. And, Double said, “a very, very few” Parkview Health-affiliated docs are selecting the same option.

That’s significant at a time when an aging population is placing more demands on already-strained health care providers.

Coordinating care

Connecting hospitals and offices to the same software is one thing. But getting separate Parkview and Lutheran software systems to talk to each other is another.

Officials for both health care providers are working to smooth their interactions.

Orlow compared the situation to the banking industry: Different banks use different brands of software, he said. But those programs need to work well with others to allow people to wire money or cash a check.

It’s the same with health care. For information technology vendors to compete, he said, they need to demonstrate that their systems will work well with others.

The Office of the National Coordinator for Health Information Technology – or ONC – reviews and certifies various software packages.

IT vendors are required to make sharing information through health information exchanges relatively easy, Orlow said. EpicCare, for example, is required to be able to export data. McKesson, the system Lutheran uses, is obligated to be able to import that data, he said.

Five health information exchanges now serve this market. Lutheran officials are reluctant to use them, however, because the relatively basic connections don’t display medical records in the health care provider’s chosen software, Orlow said.

Parkview’s Double said his folks have performed test-runs with an exchange.

“We have the capabilities to exchange,” he said. “We haven’t had the requests to exchange.”

Orlow believes Parkview and Lutheran staffs collaborate effectively and will continue to do so as they search for a better solution.

Double agreed.

“The patient comes first … and we’ll find the information we need to take care of that patient,” he said.