Editor’s note: This is the second in a series of articles focusing on the changing role of information technology in various sectors.
The series looks beyond the push for universal broadband, asking how Internet access and the advances of technology are changing life in Addison County. It stems from the discussions of a regional technology plan being worked on by the Addison County Regional Planning Commission. We welcome your responses and thoughts on the article or on technology in general, input that will help the team incorporate as many viewpoints as possible into the plan.
ADDISON COUNTY — While iPad-carrying doctors might seem futuristic, that image is not too far off for Porter Medical Center’s staff.
On Aug. 1, Porter flipped the switch on the first part of an information system that will digitize most functions at the hospital and its 11 satellite practices.
It’s a move toward electronic medical documentation that Ron Hallman, vice president of development and public relations at Porter, said will improve communication and coordination of care throughout not only the Porter system, but also statewide.
“It’s all about communication and coordination of care,” said Hallman. “We’re an industry of a lot of technology, and having it communicate with each other is important.”
Montpelier-based nonprofit Vermont Information Technology Leaders (VITL) works with primary care practices and hospitals around the state to help make the transition to electronic health record systems, to use them efficiently and, eventually, to allow them to communicate with any other medical practice in the state.
“When I come in unconscious in an ambulance … the health care provider, doctor or nurse, needs as much information as possible in order to rule out certain things,” said Steve Larose, vice president at VITL.
This list includes anything from allergies to medical history, which can be very difficult to access. Right now, medical providers even within the Porter system have to call between offices to request copies of paper medical records, which can cause problems during non-office hours.
Hallman said having medical records available at the click of a mouse can reduce duplicate tests and make the diagnosis process more efficient, which could save money and time.
Christine Mulholland, an electronic medical records (EMR) implementation specialist for Porter’s practices, said digital medical records will also make it easier for doctors to see if a patient is missing routine tests, which can lead to better preventative care.
“It’s too early to put numbers to things, and I don’t know if we’ll be able to pin a dollar amount onto it,” said Hallman. “But there’s no doubt that it will make us more efficient, and provide both systems savings and savings for the individual.”
CHANGING TIMES
On Aug. 1 at midnight, the first part of the system went up in a transition that Mulholland said had only minor road bumps. After months of work by a committee of hospital employees, patient registration, scheduling and billing were part of the first rollout, as were laboratory results.
Physicians at Porter practices will now receive electronic copies of lab results rather than waiting for paper results. And though the EMR system won’t go online until early next year, Monday’s transition has already begun to save time.
Dr. Carrie Wulfman, lead physician at Neshobe Family Medicine, said that until the new system rolled out, she had to drive from Brandon to Middlebury in order to sign paper charts at the hospital — sometimes making the journey for just one or two charts.
Wulfman’s practice has been on an electronic medical system since 2000, one of only three Porter practices already digitizing their records. Her practice will be transferring over to new software next year to conform with the rest of the system, and Wulfman said compatibility with the rest of Porter will make a big difference.
“There are times now when a patient will come to see me for the hospital follow-up, and the paper records haven’t caught up yet,” she said. “I can’t do as good a job as if the paperwork was here.”
And as the full system rolls out, she said, she will be able to access records from home, meaning that she can look up a patient’s information while she is on call.
“I’ll be able to access more information, and there will be less room for mistakes and omitted information,” she said.
Mulholland said the process of switching to a digital system has also allowed all of the practices to take a step back and make their general procedures as efficient as possible.
“Throughout the process, we’ve mapped our workflows and tried to make improvements where we can,” she said. “Hopefully if we’re more efficient with the medical stuff, we’ll spend more time on patient care.”
Larose said that security of these digitized medical records is always a concern, but VITL carefully tests all systems that go online to ensure their security, and Larose said all records are heavily password-protected. All remote-access websites are protected with secure connections. All around, Larose said that’s a big step forward from paper charts.
“Paper charts are not very private,” he said. “Anyone who physically walked back (to the shelves) would have access to those records.”
A VISIBLE SWITCH
Mulholland said that as the electronic records system rolls out, the patient experience will change as well. Exam rooms will have computers, and patients will also see doctors and nurses carrying laptops and tablets.
With these, medical staff will be able to show patients their x-rays right from the exam room, graph test results, track records and print off a summary of the visit, instructions for the patient and any documentation.
“It will help with patient education,” said Mulholland.
Rainbow Pediatrics and Middlebury Family Health, both Middlebury private practices that work in partnership with Porter, are both using EMR systems now — Middlebury Family Health since January and Rainbow Pediatrics since November.
At Middlebury Family Health, doctors and nurses carry laptops when they see patients. At Rainbow Pediatrics, doctors use tablets.
Office manager Lisa Ryan said the introduction of a screen into the exam room was initially a source of worry.
“At the beginning, the providers were worried that this would be more impersonal,” said Ryan.
But the whole practice made an effort to explain the changeover to patients and their parents, and to ensure that the eye contact and personal touch was still there.
“It’s actually become better in the room,” said Ryan.
And Ryan said the EMR system has made a difference in the office’s efficiency. Doctors can enter patient information into the tablets in the room, and can do follow-up charting from home without worrying about taking paper charts out of the office.
“There’s less paper, so there’s less room for error,” she said.
A STATEWIDE SYSTEM
Larose said many health care providers are choosing to make the switch to digital for the purposes of better patient care, but there is also a great deal of federal and state pressure to change over, with the hope that it will lead to better efficiency in the larger medical system.
As part of the American Reinvestment and Recovery Act of 2009, the government offers financial incentives to medical providers who have made the switch to medical records and can prove that they are being used in a meaningful way. Though the up-front cost of software and the time to implement the system can be daunting, Larose said those financial incentives can be a big help.
While practices in Vermont are in various stages of making the switch, Middlebury Family Health on Monday became the first primary care practice in Vermont to achieve the “Meaningful Use” benchmarks set by the federal government, as its medical records system is now supplemented with electronic lab result delivery from the hospital.
Hallman said Sen. Patrick Leahy, D-Vt., may visit Middlebury Family Health next week to observe the milestone.
And statewide, VITL is working on the Vermont Health Information Exchange, which the Vermont legislature commissioned to allow providers throughout the state to pull a patient’s medical records from any other provider on the exchange.
In addition to Porter, 80 percent of the primary care providers in the state are working with VITL to set up systems that can be plugged into the exchange. Larose said that while many hospitals across the nation are in the process or done with the transition to EMR systems, in Vermont small providers are ahead of the curve.
“You don’t find that 75 percent or greater number anywhere else in the country,” said Steve Larose at VITL. “We’re leading in terms of the percentage of providers who are making the transition, and I think that really speaks to the quality of the health care providers that we have in the state.”
Lisa Ryan of Rainbow Pediatrics said that her office sees patients from Middlebury Family Health and other pediatrics practices from time to time, and having systems that can talk to each other will make a big difference.
“It’s important that our interface will communicate with (Porter’s system), so that when we see their patients on the weekend we’ll have all the patient information,” she said.
For some, however, that’s a long way off. With 50 years of paper records, Porter Medical Center practices have a lot of data to scan into the system. And even for small practices, digitization is a long-term goal.
“We’re still scanning charts,” said Ryan. “We had to hire extra staff to scan, and we’re probably about halfway through.”
Larose said after primary care providers come on line, the hope is that medical health providers, home health care providers, nursing homes, and others not covered by the federal incentives will move toward similar electronic systems.
And long-term, the hope is a national or even international system.
“We hope it will lead to a health care system that does allow for better coordination of care, whether you’re in Vermont, Florida or California,” said Hallman.
Reporter Andrea Suozzo is at [email protected].