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Backstage at the Medical Revolution

Behind-the-scenes technologies are transforming medicine -- but who's gonna pay?

For the Record

Another innovation that's found a niche in a few leading hospitals -- such as Boston's Beth Israel Deaconess Medical Center -- is the online medical record. The OMR, as initial-loving doctors call it, is an electronic version of the old paper folders bulging with notes, lab test results, copies of prescription orders, letters between doctors and patients, referral slips, etc.

Paper records take up warehouses full of space, they weigh a ton, they take a lot of time to duplicate, and they need to be shipped from one place to another whenever a patient switches doctors or sees a specialist.

But imagine if every time you went to a new doctor, all you had to do was give him or her a password granting access to all of your medical records instantaneously.

"The online medical record is an electronic health record. It has a place for doctors and nurses to enter the medication list and the problem list, keep track of blood pressures and store their notes and so on," explains Daniel Z. Sands, MD, MPH, assistant professor of medicine at Harvard Medical School, and clinical systems integration architect at Beth Israel Deaconess Medical Center in Boston.

He says the online medical record grew out of a need to impose order on the chaos of modern medical life.

"Medicine is increasingly complex, and we don't have a lot of time to spend with you in the exam room. We're dealing with an incredible amount of information and keeping track of this information isn't really manageable using paper. Having a computer system there is a very important safety net for us, and it really makes it possible to provide quality health care," Sands tells WebMD.

"We know from doctors who've left the organization, one of the things they miss the most is that computerized patient record system."

Who Wants the Tab?

So with all this wonderful technology promising to make things more efficient, reduce workload, and improve delivery of services to patients, why aren't more hospitals using it?

"We live in two worlds: the world of the possible and the world of reality," says Jerome H. Grossman, MD, senior fellow and director of the Harvard/Kennedy Health Care Delivery Policy Program, at the Kennedy School of Government at Harvard University in Cambridge, Mass.

"All of this technology is possible and exists, and we know it's possible because it exists in at least one place. But scaling it up has proven to be an absolute, insurmountable barrier."

Despite more than 30 years of rapid development in computer technology, less than 5% of patient medical records are currently automated. The problem is that the people who hold the purse strings at hospitals tend to be interested in one thing, Grossman says, and that's ROI, or "return on investment." Information systems call for a big cash investment upfront and on uncertain benefits down the line.

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