Electronic Medical Records: Charting Mayo Clinic's Progress - ' Benefits and Burdens '

Benefits and Burdens

When Mayo Jacksonville deployed the outpatient system, a key goal was to save money—an issue that other health-care organizations contend with as well. "We all know about that mass of baby boomers marching toward retirement years ... the different forecasts about when Medicare is going broke," says Reg Smith, administrator of Mayo's advanced technology innovation and planning office. Electronic records, he says, hold a good promise of reducing the paper shuffle and the associated administrative costs.

Mayo's outpatient practice in Jacksonville previously retained six paramedical employees for every one of its 150 physicians at the time, but that number dropped to about five paramedics by 1998, according to Mentel. At the time, that represented an annual savings of $5 million to $7 million, taking into account additional expenses for software, hardware and support.

Proponents of a paper-free hospital say that an automated clinical practice can make medical staff more effective and improve patient care. For example, when new test results are reported in a hospital patient's file, they will be highlighted so that a nurse or doctor will be able to see them immediately—rather than wait for a paper report to arrive.

Still, pain comes with change.

The move to a paperless system in Jacksonville's outpatient offices required physicians to revise work habits. Doctors, who previously wrote out notes from a patient exam or consultation on a paper chart, are now expected to dictate this information. The notes are first transcribed by voice recognition software, Dolbey's M2 Transcription, then tweaked by a transcriber and forwarded to a physician for review—as text in a document in the Cerner PowerChart Office suite.

Hospital physicians will have to rely more on their computers. That's because a patient's progress notes need to be reviewed throughout the day, and they cannot wait to be transcribed.

Gonwa expects to hear some teeth gnashing when the order-entry system goes live on Nov. 6. "The day we turn this on, some people are going to scream bloody murder [and say], 'It's a lot easier for me to write an order than to do it electronically,'" he writes in an e-mail, acknowledging that physicians will need to spend more time inputting information, such as orders for tests and treatments, into the computer.

Under a paper-based system, a physician is able to write out on paper an order such as "CBC at 8 PM, if Hg < 8 then transfuse 2 units PRBC." (Translation: Take a complete blood count at 8 p.m. Check the results. If the hemoglobin is less than 8, transfuse 2 units packed red blood cells.) Writing this order takes five to 10 seconds, but Gonwa estimates it will take a physician three steps over 60 seconds to input the instructions into the computerized order-entry system.

"Most [physicians] do not know the steps that go on after they write a seemingly simple order," Gonwa says. "They are used to it just happening. The patient safety benefits outweigh the complaints."

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