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Hospitals crossing the digital divide; UMass Memorial moving ahead with e-record system.

Byline: Lisa Eckelbecker

LEOMINSTER - Nearly six years of effort - and millions of dollars in information technology - at HealthAlliance Hospital gets you this: A message on a computer screen reminding you to raise the head of your patient's bed, so he does not develop pneumonia.

It might seem mundane, but it's a hallmark of the effort to remove paper and clipboards from hospitals and replace them with electronic health records that are capable of bringing order to scribbles - and maybe improving medical care.

All hospitals are facing the need to digitize their record-keeping, but hospitals such as HealthAlliance are moving faster than others. The 150-bed hospital with campuses in Leominster and Fitchburg recently reported to federal authorities that it had attained "meaningful use" of its electronic health record system for at least 90 successive days. That makes HealthAlliance the first hospital in the UMass Memorial Health Care system, the dominant hospital system in Central Massachusetts, to hit the milestone. Online federal records show only three Massachusetts hospitals had reached the mark as of October, led by Beth Israel Deaconess Medical Center in Boston, which was the first hospital in the nation to achieve "meaningful use."

"This is a tremendous step forward in how we are able to take care of our patients and make it seem very seamless," said Karen M. Marhefka, health information administrator for UMass Memorial.

U.S. hospitals have been slow to adopt electronic records, and for good reason. The systems represent a substantial capital investment. UMass Memorial estimates it is spending more than $100 million on electronic records systems for its five hospitals and its 1,600-physician medical group.

It also takes time and effort to train doctors, nurses and other medical professionals to use the systems.

When Harvard School of Public Health researchers examined survey results from U.S. acute care hospitals in 2009, they found only 2.7 percent of hospitals had comprehensive electronic record systems in place. Even after adding in hospitals with basic electronic systems that served at least one clinical unit, only 11.9 percent of U.S. hospitals had electronic systems in place, the researchers said in a 2010 article in the journal Health Affairs.

Health technology systems are still relatively new, and pioneering hospitals had to build their own systems, said David P. Smith, a senior director of the Massachusetts Hospital Association, a trade group.

"It's not something that someone would undertake lightly," Mr. Smith said. "It's all-encompassing on an institution."

Yet good reasons to go digital also exist. Proponents say electronic records give doctors and nurses more information about their patients, access to guidelines on the best way to treat specific conditions, and warnings when a prescription, dose or treatment runs up against recommendations.

"Manual paper charts are inefficient. They're not well accessible," said Margaret M. Campbell, a registered nurse and HealthAlliance's associate chief information officer. "We knew you had to get all that information electronically in one place. The development of the electronic health record was something that needed to happen, and people in health care knew that."

Federal policymakers began to push for health information technology adoption during the administration of President George W. Bush. Then in 2009, President Barack Obama signed legislation providing $19.2 billion in stimulus money for Medicare and Medicaid payments to medical providers that are able to demonstrate "meaningful use" of health technology.

Medicare is the nation's health insurance program for seniors and the disabled, and Medicaid is a state-federal health insurance program for the poor. Both programs provide critical streams of revenue for hospitals.

To show "meaningful use" of electronic records, hospitals must use the technology for certain tasks, such as prescribing drugs, and demonstrate that they are improving health care in ways that can be measured.

HealthAlliance estimated it would receive nearly $1.9 million in payments for attesting that it had achieved "meaningful use" of its system by Nov. 30, the deadline for hospitals hoping to receive payments in the current federal fiscal year.

When HealthAlliance officials gathered in a conference room recently to submit their "material use" information - electronically, of course - it came after six years of effort. The hospital flipped the switch on its Siemens Healthcare records system in 2005.

Physicians had to learn to integrate the system into their interactions with patients, according to Chief Medical Officer Dr. Daniel J. O'Leary.

"What you want to do is spend some time with the patient, and time you spend searching for information is time lost from the patient interview and patient interaction," Dr. O'Leary said.

The hospital configured computer workstations for doctors, nurses and other hospital personnel to access electronic records. As people have become more adept at using the system, it has become more natural, Dr. O'Leary said.

"Sometimes I feel like my teenager would love it more than I do," he said. "But the benefits are so alluring, and one becomes unsatisfied with the old record."

The system only covers inpatient care so far. Off-site doctors with Internet access can log on to the system to obtain information about patients, but the system is not yet connected to doctors' offices.

"We're working on that," said Patrick L. Muldoon, president and chief executive of HealthAlliance. "We want to have one record in the future."

UMass Memorial aims to follow in HealthAlliance's path in the coming months. Mrs. Marhefka said the University and Memorial campuses of UMass Memorial in Worcester will be the next hospitals to hit the "meaningful use" milestone, followed by Marlboro Hospital, Clinton Hospital and then Wing Memorial Hospital in Palmer. The embrace of electronic records could bring the system an additional $20 million in government insurance payments, she said.

Then there's the next phase of "meaningful use." So far, HealthAlliance has only attested that it has met the federal guidelines. Next it will have to prove it through audits. Guidelines are due to be issued in early 2012.

"I'm pretty confident that we'll be positioned, not without a lot of work, but we're definitely going down the right track," Ms. Campbell said.


CUTLINE: (1) HealthAlliance Hospital registered nurses Debbie Price, left, and Michele McDonough use mobile computers to access patients' electronic health records at the hospital's Leominster campus. (2) While patient Gregory Appleton of Templeton looks on, Dr. Payam Aghassi uses a mobile computer to access Mr. Appleton's electronic health records at HealthAlliance Hospital - Leominster Campus. (3) HealthAlliance Hospital's Chief Medical Officer Dr. Daniel J. O'Leary and Associate Chief Information Officer Margaret M. Campbell. (GRAPH) Electronic health records (CHART) U.S. government's "meaningful use" criteria

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Publication:Telegram & Gazette (Worcester, MA)
Date:Dec 4, 2011
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