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
"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
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.