The future of electronic medical records, in one doctor’s visit
If you want a glimpse into the future of health care, there’s a good crystal ball here in our nation’s capital: the D.C. Primary and Immediate Care Clinic. I spent Tuesday morning there, not as a reporter, but as a patient with a fever and earache. Still, the visit turned out to be incredibly illuminating in ways that had nothing to do with my diagnosis, and everything to do with the future of electronic medical records.
Both the health reform law and the stimulus put serious money behind moving our health care system off paper and onto electronic medical records. The Recovery Act alone puts $19 billion into incentive programs to reward doctors who meet “meaningful use” standards for electronic records. The Affordable Care Act builds on that, providing additional funds to get doctors to go digital.
From the moment I walked in the door, the clinic felt like a model of what these laws are meant to encourage. In reception, I entered my information into a laptop. In the exam room, my medical history, blood pressure, temperature, and details of my earache went straight into a computer, too. I left with a prescription for ear pain medication, as well as a user name and password, so I could access my record at home and, if need be, make additional appointments.
But the clinic also seemed stuck in a lot of what’s frustrating about health care. With the medical assistant, I went through the listing of my surgeries, allergic reactions, family history. The process of rattling off my medical history - which I’ve done dozens of times before, for dozens of other doctors - took longer than the actual appointment. I didn’t even do very well at it; I couldn’t remember the whooping cough medication I was allergic too, so I guessed. But since the computers here aren’t connected to the computers for other doctors I’ve seen, there was no better way about it.
After my visit, I called the clinic’s CEO and co-owner, Christopher Timm to talk more about his practice’s electronic medical records. Timm, a doctor with a master’s in health system administration, told me that they were a must from the get-go. The way he sees it, digital documents are both good medicine and good business, reducing errors and saving money.
“We’re using technology to aid our patients and to be more affordable,” Timm told me. “Everybody has a laptop or iPad and is comfortable with that. Think of the costs were able to save. Do you know how much you’d pay for square-footage to store medical records in D.C.? We’d prefer to use our space for clinical aspects.”
But when it comes to working with nearby health providers, it’s a different story. Timm estimates that fewer than a quarter of other practitioners have sufficient technology to get their computers talking to his clinic’s computers.
“It took us about six months to get compliant with Health Level 7,” Timm says, referring to the new, voluntary standard for electronic medical records that’s meant to make any record available to share with any hospital, doctor’s office or other health care facility. Note: participating in that standard is completely voluntary, so uptake has been slow.
“I think we’re still about five years away from having all systems talking to each other,” says Timm.
Five years is actually a pretty optimistic timeline, when you think of what needs to happen. A survey in January found that only 10 percent of physicians are completely digital; the other 90 percent still need to get on board. Then, all of their clinics need to make sure that their platforms are inter-operable, able to communicate with one another.
D.C. Primary and Immediate Care is charging full speed ahead on its own electronic system. In three weeks, Timm says, it will roll out new technology that allows patients to fill out their medical history at home when registering for the visit. He’s looking into applying for stimulus funding, too.
But how far Timm’s clinic can go depends less on his clinic than on factors he can’t control: namely, how digital all the health providers around him want to get. What the clinic needs most isn’t just its own improvements, but rather other clinics that its computers can talk to.