Electronic medical records have replaced paper records in most health settings, but in the huge and varied medical world, there is room for improvement.
Greg Kenien, cardiologist and chief medical information officer at St. Joseph’s Hospital in Syracuse, has a bird's-eye view of the changing world of medical records.
“Ultimately, the potential is enormously for the good, but we’re having some growing pains now,” Kenien said.
He said he likes the potential of using these medical records to track populations to determine who may be at risk for certain illnesses. For example, at St. Joe’s, physicians are installing a predictive analytic model to determine who may be at most risk of sepsis, a potentially life-threatening complication of infection.
Instead of just looking at a person’s pulse, blood pressure, white blood cell count or respiratory rate, Kenien said doctors put in 120 data points from a person’s hospital charts, including kidney function, liver function, age and narcotic problems.
“Put in 120 things, and then the model will tell us, and then hopefully learn from itself, people who are at risk for sepsis,” Kenien said.
The hospital would then know to monitor those individuals extra closely. The use of electronic medical records also helps on a more individual level, slashing drug interaction rates and offering patients the opportunity to keep track of their own health data. But not all health care facilities have the same needs.
Loretto is a post-acute care facility in Syracuse. Chief Information Officer Brandon Claps said it is moving toward a new electronic medical records system to integrate medical records into all aspects of care.
“The acute care space, hospitals, they’re much more far advanced [in] the capabilities of their EMR because of their large vendors,” Claps said. “The post-acute care space is coming up there and having data at your fingertips, and I think the data will be there from the population.”
Chances are, though, the vendor used by Loretto is not the same one used by St. Joe’s. This leads to one of the biggest challenges in the digital record world: interoperability – the difficulty of one software program to talk to another and transfer records in a usable manner.
Karen Fabrizio, chair of the Health Information Technology program at Onondaga Community College, said part of that can be eased through health information exchanges, of which New York has eight.
“A lot of people refer them to as RIO’s – Regional Health Information Organizations,” Fabrizio said. “These are organizations that take data from the facility and hold it in a repository. There’s a lot of protocol in place to make sure a physician or hospital has access to that information.”
That access to information, though, does not entirely solve the added burden of disparate systems that do not allow seamless transfer of information. Kenien hopes that can be overcome with improvements in medical software.
“I think medical software is behind where consumer software is,” Kenien said. “As that medical software gets better and more friendly to doctors, patients and nurses, then things will improve.”
On the ground, the use of electronic medical records gets mixed reviews. Claps said the new system will help nurses at Loretto.
“It’s going to allow our nurses to spend more time with residents and less time worrying about different pieces of paper, having to ask for one medication or another or documentation,” Claps said. “It’s all going to be done with finger clicks instead of a timely consumption of data.”
Kenien said that, from a physician’s point of view, all the extra screen time can take away from patient time.
“Sometimes, you can get swamped,” Kenien said. “You get so much information that the one important piece you miss.”
But, in the end, Kenien said doctors would never go back to paper.
“Every note is legible, and…I can look at the EKG or records without leaving my house,” Kenien said. “I don’t think anyone would go back to the old days.”