PAMF Electronic Health Record Power

By Albert S. Chan, M.D.,M.S.

Recently, I saw a 28-year-old female with vague complaints of fatigue. On her initial visit to the Palo Alto Medical Foundation (PAMF), I took a standard medical history, including a diagnosis of systemic lupus erythematous, and entered the information into PAMF’s comprehensive electronic health record (EHR) system. The patient reported that her condition was well controlled and said she would prefer to hold off on laboratory tests, which had recently been performed at a different clinic. She left my office asymptomatic with a promise to obtain her records from the previous physician.

At a follow-up visit, I noticed the patient seemed lethargic compared with her prior visits. She also showed a significant increase in blood pressure. I ordered routine blood tests to evaluate her symptoms. Unfortunately, her old medical records had not yet arrived.

Later that afternoon, a colleague was covering for me when a critical message arrived from the laboratory: the patient was in acute renal failure. Because her information was readily available through the EHR, my colleague was able to quickly review the patient’s chart, notify her of the results and admit her to the hospital­—where the physicians who treated her also had easy access to the EHR.

When I returned to the office the next day, notes in the EHR showed that my patient had received proper care overnight. After she was discharged, the hospital physician entered a summary of her inpatient stay into the record. Subsequent visits to PAMF specialists in nephrology and rheumatology were also captured electronically, and I was able to follow the patient’s progress from my desk.

Meanwhile, the patient herself remained involved through PAMFOnline (www.pamfonline.org), a service that uses the EHR system to let patients access key portions of their medical records, view laboratory test results, request prescription renewals and appointments, and communicate with their doctors through the Internet. Should she ever move or require care at another facility, her records will be easily portable.

This anecdote illustrates the EHR’s power to improve patient care quality, safety, and satisfaction. If used to its fullest potential, the EHR is much more than a simple repository of clinical data. At PAMF, our system lets physicians and clinical staff members quickly access patient information from any department or facility, without chasing down paper records. It can send electronic prescriptions to pharmacies, reducing the risk that hard-to-read handwriting will lead to medical errors. It flags potentially harmful drug interactions; provides doctors with decision-support tools; and generates printed post-visit summaries for patients, among other benefits.

EHRs can also improve physician efficiency and save money for the busy medical office. According to a recent survey in Medical Economics, physicians who have implemented EHRs have seen cost savings from partial or complete elimination of transcription costs, reduced labor for paper chart handling, and improved documentation of evaluation and management (E&M) charges. 

In light of these benefits, President Bush in April 2004 announced a goal to give most Americans access to EHRs within the next 10 years. The president proposed investing $100 million in health information technology (IT) projects and appointed a new national health IT coordinator, David Brailer, M.D., Ph.D., to lead the effort. At a recent Stanford University conference on medical informatics, Dr. Brailer remarked that EHRs have great potential to improve patient safety. The Institute of Medicine (IOM), he said, “has essentially proven that paper charts lead to medical errors and deaths.”

Expanding patient access to electronic records will require nearly all physician offices in the nation to install EHR systems–no easy feat. Paying for complex new computer systems, changing ingrained practice styles, and ensuring patient privacy protection all pose hurdles, no matter how large or small the office. As a result, only about 10 percent of U.S. health care organizations currently have a comprehensive EHR in place.

In his speech, Dr. Brailer noted that the public, private, and not-for-profit sectors must work together to overcome these challenges. Several ideas are already on the table. In 2003, an IOM committee–chaired by Paul Tang, M.D., PAMF’s chief medical information officer and chairman-elect of the American Medical Informatics Association– recommended that the government provide financial incentives to encourage physicians, hospitals, and other providers to invest in comprehensive EHR technologies. Today, Dr. Tang continues to help administration officials work to implement these recommendations.

Another promising initiative is the Doctor’s Office Quality–Information Technology (DOQ-IT) project. Sponsored by the Centers for Medicare and Medicaid Services (CMS), DOQ-IT provides small- and medium-sized doctors’ offices with training and support during EHR implementation. Involving smaller physician practices is vital if we are to realize the most powerful potential gains from health IT, such as the ability to easily share medical records between providers and the creation of a national network for early detection of disease outbreaks or bioterrorism attacks.

The goal of these efforts may be best summarized by U.S. Senate Majority Leader William Frist, M.D., who in a recent New England Journal of Medicine article said, “Widespread adoption of electronic health records will reduce errors, improve quality, eliminate paperwork, and improve efficiency.” Information technology, he concluded, is crucial to provide America with the “21st-century health care system we must have.”

Today, my patient is slowly working her way through recovery. Thanks to the EHR and PAMFOnline, she has become an empowered partner in her care, able to access her own health information, manage her medications, and keep her PAMF doctors informed about her condition. From my perspective, her involvement is just one of many ways in which the EHR has helped her physicians maximize the quality of her medical care, and the care of every other patient we serve.  

Dr. Chan practices family medicine in Redwood City. He holds a master’s degree in biomedical informatics and has championed the use of EHRs.