BILL RADFORD; THE GAZETTE

July 23, 2003

It's a familiar routine.

When you go to your doctor, you sign in, wait a bit. Sometimes there's a search for your chart. "When were you in last?" a puzzled office worker asks.

Your file, a folder thick with papers, is found, and then grows as first the nurse, then the doctor, add to it.

At the end of your visit, you're given a piece of paper to drop off on your way out, and perhaps another piece of paper with a prescription.

Some local doctor offices are shaking up that routine by adopting electronic medical records, electronic prescribing and other "eHealth" tools. Proponents - such as the eHealth Initiative, a Washington, D.C.-based nonprofit that promotes the role of information technology - say the move will improve care, reduce medical errors and ease the crushing load of paperwork faced by most doctor offices.

The eHealth movement still is in the early stages, acknowledges Janet Marchibroda, chief executive offi-cer of the eHealth Initiative. Less than 5 percent of practicing clinicians, for example, use electronic health records in their practices.

Although concerns such as cost, privacy and security have stood in the way, momentum is growing, Marchibroda adds. Physician surveys show the use of eHealth tools has grown behind an early core group of users and is entering the mainstream.

Dr. Jay Adler, a family physician with Colorado Springs Health Partners, has embraced the future. Don't bother looking for a room full of charts in his office: All his records are electronic. Patient information is always at Adler's fingertips via the wireless pen tablet he carries throughout the day, and prescriptions are faxed directly to a patient's pharmacy.

"For some people, to go through the office visit without ever having seen their chart or having a piece of paper to give to anybody is very disconcerting," Adler acknowledges.

The transition, which began two years ago and involved the gradual scanning of all records into the computer system, was a bit of a struggle for Alder as well. The pen tablet, a hand-held computer larger than a palm digital assistant and smaller than a laptop, initially seemed like "an intrusion" into the doctor- patient relationship.

And documenting the visit through the pen tablet required Adler to adopt a more structured approach in addressing a patient's multiple complaints.

"The computer," he says, "tends to want to force you into doing things in a more linear fashion."

Yet he would never want to go back to a paper-filled environment.

"I would find it cumbersome," he says. With electronic records, he explains, there's a quiet not found in offices where staffers shout back and forth for charts. When a patient calls, he can immediately call up the chart instead of relying on his memory or returning the call later.

"The other thing that is very nice is that everything in our office is now documented: every message, every phone call, every communication with a patient. What I used to have was a myriad of stickies all over the place."

A group of internal-medicine doctors at the CSHP office on Lehman Drive and Adler served as pilot programs for Colorado Springs Health Partners. The health organization will convert all of its 11 offices to the Amicore Clinical Management system.

The transition at CSHP will involve converting roughly 130,000 patient records from paper to electronic files. It will take more than two years and cost more than $2 million, says Mario Iorio, executive vice president and CEO of CSHP.

But the advantages are tremendous, he adds.

"The access to information just becomes so much quicker. It really is a huge time-saver."

Two natural concerns are the safety and privacy of the electronic data.

Those concerns have been addressed, Iorio says.

"All of our data is backed up twice and is kept in different locations," explains Iorio, who believes the risk of losing electronic data is less than that of losing paper records.

Colorado Otolaryngology Associates in Colorado Springs has had its electronic-records system for more than two years. Instantly available information and more-complete records are among the advantages cited by Judy Boesen, the practice's administrator.

Losing or misplacing records is unavoidable in a paper-filled office, she says.

"The man-hours you spend looking for things is just unbelievable."

The groups' doctors first used pen tablets like as the one Adler carries, but abandoned them because of the small screen, Boesen says.

Now each room has a desktop computer. While doctor and patient confer, a medical assistant handles the computer work: calling up charts, updating records and so on. It means needing more medical assistants, but the office has saved in other areas, such as reducing medical-records staff.

Dr. Ripley Hollister, a family doctor and president of the El Paso County Medical Society, is just starting the transition to electronic records. He recently set up computers at each work station in his practice; the palm computer he carries with him serves as a vital reference. He can access information on medications, such as side effects, recommended dosages and contraindications.

"This isn't the only place we get this kind of information," he notes, "but here it is, just right there. It doesn't matter where I am."

Hollister heads the society's medical-information technology committee. The focus is on technology that benefits doctors and patients.

"The real issue is improving our ability to care for people in a thorough, time-effective and safe fashion," he says.

Technology can do only so much, though. The doctor, not a machine, calls the shots, Hollister says. And the relationship between doctor and patient remains critical.

"The art of medicine," he says, "will always be there."

Adler agrees.

"It's important for people to realize ... that a computer is not telling me what to examine next, what question to ask or what are my diagnosis options. The computer is not a prompt for me to figure out what the patient's problem is. It simply is a more efficient way to document what I'm already planning to do."

CONTACT THE WRITER: 636-0272 or

JODY CONDITT/ THE GAZETTE

(C) 2003 The Gazette. via ProQuest Information and Learning Company; All Rights Reserved

More Mobile Computing News