EHR: A ‘one-stop shop’ for patients’ medical records

As a document-heavy enterprise, the health-care industry has an addiction to paper. Medical records, not to mention bills and correspondence, require reams and reams of printouts—stored in thick manila folders, collected in huge filing cabinets.

Each medical office, clinic and hospital maintains its own set of records, multiplying the amount of paper per patient to a mass that would make an ecologist cringe.

Over the past two years, the federal government has sought to curb this addiction. Via the carrot (stimulus funds through the American Recovery and Reinvestment Act of 2009) and the stick (requirements in the Patient Protection and Affordable Care Act of 2010), the old-fashioned paper chart is undergoing an electronic transformation.

Any provider receiving reimbursements from the government must have a system for electronic health records up and running by the end of 2013. Early adopters qualify for financial rewards, while late stragglers face financial repercussions if they miss the deadline.

One Butte County medical center is already reaping benefits. Oroville Hospital recently learned it is one of the first 100 facilities in the nation to achieve the first stage of “meaningful use” certification for its EHR—electronic health records, also known as EMR, or electronic medical records.

As Denise LeFevre, Oroville Hospital’s chief information officer, notes: “It’s not enough just to install an EHR and use it for vital signs. You have to use it in a meaningful way in the course of patient care.”

In the eyes of the federal government, “meaningful” entails several elements. An EHR system must have functionality such as “ePrescribing,” in which doctors use computer interfaces, rather than paper pads, to prescribe medications. An EHR also must be able to compile data in formats readable by other systems to allow an “electronic exchange of health information to improve quality of health care” and “to submit clinical quality and other measures.”

Health-care providers may choose from a variety of systems, but the system chosen must communicate with other systems or it falls short of fully meeting the meaningful-use requirements.

Under the stimulus legislation, medical offices and hospitals have through 2012 to demonstrate the first level of meaningful use—basic functionality and data-sharing. Oroville Hospital did this during the fall and received $2 million for its efforts.

Butte County’s other two major hospitals should be online in 2012. Enloe Medical Center, which is completing a facilities expansion, expects to have its equipment in place by this coming spring and apply for certification in the fall. Feather River Hospital, part of the Adventist Health system, has a similar timetable for its Stage 1 application.

The federal government set 2013 as the target for Stage 2 and 2015 for Stage 3—the more advanced levels of use for computerized records systems.

Why is Oroville Hospital, of all places, on the forefront of EHR adoption? Mainly because it got a head start by adapting existing software and by doing so in-house.

Oroville Hospital uses VistA, an operating system developed for the Veterans Administration. The source code is considered a public document because it was developed by the federal government using taxpayer money, so anyone with the adequate server hardware can download VistA.

LeFevre (pronounced la-FAVE) heads the hospital’s information technology department but also serves on the board of WorldVistA, an international organization dedicated to making VistA work in a range of health-care settings. Members of WorldVistA have worked with LeFevre’s department to improve—and expedite the meaningful-use certification of—Oroville Hospital’s EHR.

The medical center has the system running throughout the hospital, and in 17 of the 20 clinics it operates. The first office, the internal-medicine practice of Dr. Matthew Fine, came online in March 2009. LeFevre’s team subsequently developed programming modules for other clinics as well as the pharmacy and labs.

Earlier this year, all of Oroville Hospital’s wards got connected to the EHR, and each doctor received an iPad to access patient information while in the medical center.

“It all goes back to accessibility,” LeFevre said. “It’s the patient’s chart, not the hospital’s or clinic’s chart. If [a care provider] can get all the information in one place, you don’t have to run around hunting for it, and it all interacts. Having a one-stop shop helps everybody.”

It also can improve the quality of care. LeFevre recalled that soon after Fine’s office got wired for the EHR, one of his patients came into the emergency room. Doctors there were able to access the patient’s chart and read handwritten notes of Fine’s that influenced the treatment they administered.

Asked if the EHR has saved lives, LeFevre responded: “We have had real-life experiences.”