Electronic Medical Records: Charting Mayo Clinic's ProgressBy Anna Maria Virzi | Posted 2006-10-02 Email Print
After maintaining paper records for decades, the renowned health-care provider has embraced digitized health information systems to better manage patient care and trim costs. Adoption has brought some pain.
The mayo clinic, known for meticulously organizing and preserving patient records over the past century, is remaking itself into a digital health-care organization.
"Health care, at its root, is an information-intensive business," says Dr. Christopher Chute, professor of biomedical information of the Rochester, Minn.-based organization. "And part of the precepts of information is making sure the information is consistent and comparable."
Mayo's Jacksonville, Fla., outpatient facility has been at the national forefront of efforts to digitize patient records. Ten years ago, it required outpatient physicians at that clinic to trade in their paper folders for an electronic filing system from software maker Cerner of Kansas City, Mo.
Despite the early success of digitizing records for the outpatient clinic, Mayo has had a tougher time moving to electronic records and practices in its St. Luke's Hospital, also in Jacksonville. In fact, a computerized physician order-entry system, which will enable hospital physicians to order tests, treatments and medications, is set to go live on Nov. 6, according to Dr. Thomas Gonwa, a surgeon leading the hospital's effort to roll out the order-entry system.
Mayo is a case study in just how difficult it's been for health-care facilities to implement electronic record systems.
Across the United States, adoption has been hampered by systems incompatibilities and the reluctance of hospital staff to change the way they work. Another barrier is cost—a system for a clinic or physician's office can reach $100,000 per physician, while a hospital-wide system can run millions of dollars. At Mayo Jacksonville, an estimated $18 million has been invested in both the inpatient and outpatient systems, according to Cheryl Croft, chair of information technology at Mayo Jacksonville and a registered nurse.
As of 2005, only 15% to 20% of physicians' offices and 20% to 25% of hospitals in the nation had adopted electronic medical records, says the RAND Corp., a research organization. Of those health-care organizations with systems, an undetermined number cannot share information with other hospitals or medical offices because of a lack of standards, says Richard Hillestad, a senior principal researcher at RAND.
But, the rewards can be great from deploying health information systems. RAND estimates that interoperable electronic medical systems could save about $77 billion, or 4.5% of the estimated $1.7 trillion spent on health care in 2003 by improving efficiency and increasing patient safety. Under the current payment setup, however, those savings largely go to health payors such as insurers and businesses.
As much as $35 billion of the savings stands to come from reduced hospital lengths-of-stay, because workflow features found in electronic records systems can better coordinate the care of patients suffering from chronic diseases. Also, health-care providers should spend less time waiting or looking for files once patient records are digitized.
Additionally, electronic prescription systems can cut medication errors by eliminating illegible handwriting and flagging allergies and potential adverse reactions to other drugs.
By one estimate, e-prescriptions can reduce serious medication errors, defined as those with potential for harm, by 55% and all medication errors by 80%, says Dr. David Bates, professor of medicine at Harvard Medical School.
But it's taken Mayo a decade to bring up the inpatient systems in Jacksonville. One reason why: A hospital's inpatient system is far more complex than an outpatient one found in a physician's office, says Dr. John Mentel, past chairman of the applied informatics department at Mayo Clinic, Jacksonville.
This complexity includes the ability to coordinate patient care across departments and specialists. "Pharmacy systems, lab systems and monitoring systems all need to function 24/7 without fail, all interconnected to facilitate the rapid movement of data due to the intensity of service needed," Mentel explains in an e-mail.
Over the past 10 years, St. Luke's has steadily moved from paper to electronic records on the Cerner software platform. Croft, the I.T. chair, outlined this schedule for adoption: Classic PharmNet for pharmacy records in 1997; surgery scheduling and documentation in 1998; and INet for the critical care unit, the Open Clinical Foundation data repository, and FirstNet for emergency-department patient tracking, all in 1999. Those hospital records, along with the outpatient physician order-entry system and other electronic documents and images, are stored in a central repository called Cerner Millennium and can be accessed by health-care staff working in Mayo's inpatient or outpatient facilities in Jacksonville.
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