Sunday, July 21, 2019


Patient medical records go electronic
Larger view
Dr. David Abelson demonstrates Park Nicollet's new electronic medical record system. Abelson says it will help doctors reduce errors. (MPR Photo/Lorna Benson)
It's been about a year since President Bush announced his plan to bring patient medical records into the computer age. The President wants most Americans to have an electronic patient record within the next decade. He says electronic records will make health care safer and more affordable. The idea poses many challenges that haven't been solved yet. Still the switch from paper to electronic records appears to be well underway in Minnesota.

St. Paul, Minn. — Park Nicollet Health Services was the first clinic and hospital system in the Twin Cities to transfer all of its patient records from paper to computer. It took three years and $60 million dollars to digitize more than two million patient records. But Vice President David Abelson says the move had to be done.

"Paper records just wouldn't cut it anymore," says Abelson. "Information exists in only one place when it's paper. It's wherever that piece of paper happens to be."

Without fast, easy access to medical records, Abelson says doctors are much more likely to make mistakes. An Institute of Medicine study estimates that up to 98,000 hospital patients are killed in the U.S. each year by medical errors.

Since last summer Park Nicollet doctors have been able to log onto a computer and view patient records from any of the system's 25 clinics and Methodist Hospital. Medical records are private, so in order to demonstrate how the system works, I gave Abelson permission to pull up my record from an appointment back in 2000.

A moment later, Abelson was reading through the notes from that visit.

"So you were here several years ago because of allergies and so we can look at your transcriptions," says Abelson. "Do you want to take a look at that?"

"Paper records just wouldn't cut it anymore. Information exists in only one place when it's paper. It's wherever that piece of paper happens to be."
- Dr. David Abelson

The record is minimal since it's based on just one appointment at Park Nicollet. And the information is no different than what appeared in my paper file. Still, Abelson says the computerized system has some significant advantages. It just takes a few keystrokes to find a record. And the system is programmed to flag treatments that don't make sense or are potentially dangerous.

"We're able to say, 'Geez, you've just prescribed medication A, but the person is also on medication B and sometimes there's some interaction between A and B," says Abelson. "'Are you sure you want to do that?'"

Park Nicollet was the first to make the electronic record switch in both its clinics and hospital. But many other Minnesota health organizations have wasted no time in catching up.

It's not clear where the technology will go from here.

Supporters want a system that would allow electronic records to move securely between health care systems. That worries Twila Brase, President of the Citizen's Council on Health Care.

"Once it's in an electronic format it's open to hackers," says Brase. "It's open to exploitation. It's open to insiders using the data and selling the data without the person's consent."

While that is possible, Dr. William Braithwaite doesn't think the security issue is a deal breaker. Braithwaite spoke in favor of electronic patient records recently at a Twin Cities conference. He is CEO of the E-Health Initiative, a Washington-based non-profit that is pushing for a nationwide electronic medical record system.

"I think that there is a minority of patients who are extremely sensitive about their privacy for a variety of reasons," says Braithwaite. "I expect that those people will be quite vocal because they're worried that the privacy and security concerns haven't been address adequately yet. But I think we're moving very rapidly to addressing those issues."

There are a number of ideas on how to safely manage electronic patient records. One approach would store the information on Internet sites controlled by health care providers. Patients could then access their medical record using a password. But if a patient sees a lot of different doctors, the drawback to that plan is that their information would be on a lot of different sites.

Others think patients should carry their personal medical information on a USB drive that they can plug in to their doctor's computer. They could take their information anywhere they want. But the could also easily misplace a small USB drive.

Whatever the solution, technology experts say it will probably be years before the country agrees on a system that gives patients a truly portable electronic medical record that they can take with them to any doctor in any state.