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Clinical Corner

Medical Records Go High-Tech

A Q & A with John Halamka, MD, Chief Information Officer of Beth Israel Deaconess Medical Center

How are electronic medical records (EMR) better than the old fashioned paper chart?

First and foremost, electronic health records enable coordination of a patient's care among providers. Take the case of a middle-age man who comes to the emergency department with chest pain. If his medical record is available in an electronic database, and the ED physician is authorized to access it, that physician would have instant access to that man's medical history - recent check-ups, test results, medication use, and issues with heart trouble in the past, etc. With this information, the doctor will be able to make better decisions about how to best treat the patient, avoiding potential errors.

Having data placed into an electronic system also makes it possible to track and measure outcomes of care - allowing clinicians to set goals to improve quality of care as time goes on. EMR systems can also send alerts and reminders to clinicians so that right care is delivered at the right time. It can produce an onscreen warning, for example, to alert the doctor of a potential interaction between medications.

Paper is hard to share (and sometimes hard to read), impossible to analyze, and not able to notify clinicians when a combination of patient events requires urgent intervention. EMR is a tremendous step forward in preventing medical errors, cutting down on costs, and providing the very best care possible.

BIDMC CIO John Halamka, MD, uses his Blackberry on a New Hampshire mountainside 2,000 feet above Interstate 93.

How secure is my electronic medical record?

Not only are paper records inefficient, they are completely insecure. With electronic records, I can audit every keystroke to determine who can see what, when. We can respect patient privacy and manage their preferences on who sees what material and who does not.

While the technology allows for increased efficiency and secure management of patient information, implementing and ensuring the highest level of protection does take a significant amount of knowledge and work. At Beth Israel Deaconess, we spend over a million dollars each year making sure our servers, networks, and mobile devices are secure.

If my medical records are now loaded into a computer program, is there a way I can access them?

BIDMC strongly supports patient and family engagement. We were one of the first hospitals in the country to offer personal health records via PatientSite. This tool allows patients to see everything from test results to their upcoming appointment schedule. It also allows them to request medication refills online and ask their physicians questions.

We are also the leaders of a nationwide pilot in which doctors share their clinical notes with patients online. A few days after an office visit, patients can log onto PatientSite and read the physician report. The project, called "Open Notes," involves more than 100 doctors and 25,000 patients. The aim is to improve communication between doctors and patients. The results of this pilot are being studied and could become a model for how doctors communicate with their patients in the future.

What do you see as the future of technology, when it comes to documenting a patient's medical history?

The iPad has already proven to be an important tool in healthcare. BIDMC has been a leader in the adoption of iPad technology, taking in information about patient symptoms in the emergency room and using it to educate patients about how best to take care of themselves upon discharge. We've figured out how to keep iPads secure and disinfected. We've also implemented pioneering voice recognition technologies, bar code technologies and data-sharing technologies. In terms of imaging, we have not used old-fashioned film X-rays since 2000 (images are now digitally taken and stored). We've also largely eliminated handwritten orders, instead making them part of the patient's EMR.

In 2012, we'll focus on additional medication safety technologies, advanced analytic capabilities, and eliminating paper on our inpatient wards. Technology, as long as it is implemented and managed prudently, will continue to play an increasingly important role in healthcare.

For more on technology and its impact on medicine
, check out Dr. Halamka's blog, "Life as a HealthCare CIO," at .

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted November 2011