HARTFORD — Electronic medical records could potentially cut Connecticut’s health care costs, experts told a state panel, but thorny ethical and technical questions must first be addressed.
That’s where you come in.The Connecticut Health Policy Project, which is taking the first steps toward establishing electronic medical records here, wants consumers to pose as many queries as possible, members of the organization’s board of directors told a group largely composed of state health officials Monday.
The Health Policy Project and AARP sponsored the forum at the state Capitol with an eye on how coming digitization will affect consumers and advocates.
Ellen Andrews, the project’s executive director, said the central issues of medical record-keeping — security, privacy, and efficiency — must be addressed before the state even considers a system.
For example: Who owns virtual medical records, you or the doctor? How could the sale of medical information be prevented? How can system be made hack-proof? How will dissimilar computers using different systems communicate?
“Consumers need to be paying attention. A lot of numbers are involved, and we need consumers involved,” Andrews said.
A lof of money is also involved. Connecticut spends about $22 billion a year on health care.
(Click here for a previous story about the state’s efforts to computerize medical records.)
The CT Health Policy Project envisions a computerized system able to maintain medical histories, flag conflicting prescriptions, track changes in weight and blood pressure, and other factors, and be readily accessible from any hospital in the U.S.
The organization responsible for carrying out the health policy plans is eHealth Connecticut, a non-profit organization chartered in 2006.
Andrews and Dr. Kevin Carr (pictured), assistant clinical professor of medicine at Yale, blame the relatively low U.S. life expectancy, the high rate of medical errors, and high cost of care to the traditional use of paper records.
Carr said “silos” of paper records are typically impossible for other doctors to get their hands on during an emergency, and are often difficult to comprehend, under an accumulation of doctor’s chicken-scratch notes.
“How old is paper?” Carr asked. (It is about 2,000 years old).
“It’s interesting that doctors use paper, templates, and notes to record prescriptions, diagnoses, and all other problems, in a chart, in a file cabinet,” he said.
Safely locked away, the records are not accessible to anyone except the doctor’s staff, he said.
Information migrates slowly from one specialist’s files to another’s, he said.
Carr, citing the National Institute of Medicine, said 17 percent of Americans report that in the past two years previous test results or medical records were not available at the time of an appointment.
This is one of the main reasons that approximately 98,000 patients die from medical errors in hospitals every year, Carr said. He said electronic medical records could prevent 2 million non-fatal mistakes a year.
Carr said that he has been hospitalized three times and experienced medical errors on two of the occasions. Once he received the wrong intravenous drip, he said, and in the second case external sutures were used internally.
“There are silos of paper information. What if we could break them down in a safe way and digitize them, patients could be treated more effectively,” he said.
Carr said computerized records could reduce errors and ensure continuity of care. “Now prescriptions are written into charts. As humans we make mistakes,” he said, so the medication may not be recorded, and perhaps the recorded but in an incorrect dosage.
Computers are well suited to flag inconsistencies, conflicting prescriptions, and sound-alike drugs. For instance, a records program could automatically list all likely drugs after the doctor types in three letters.
That’s all well and good, one person asked Monday. But how is the quality of the entries themselves guaranteed? An inattentive worker could just as easily skip entering a medication on a computer screen as on a sheet of paper.
A prescription recording program, or sub-program, might be able to highlight the mistake, but electronic records do not relieve clerical workers of all responsibility, he said.
Meanwhile, the federal government has created a certification process for electronic medical records systems. The systems are supposedly impossible to break into. However, hackers have penetrated the Pentagon, which presumably has a high level of security.
Other issues arise if the patient is away from home and requires medical care. Perhaps the patient would not want to reveal his HIV status. Could a condensed version of the records be made available?
But even if HIV is left unmentioned, a health care worker would recognize HIV/AIDS drugs immediately.
While there’s no way to tell whether paper records have been examined by a snoop, a computer could trace all access, Carr said.
“A huge amount of work has been done so that the information cannot be copied or hacked into,” he said.
“We need to develop a policy about privacy,” Andrews said.
For more information or to get involved, visit the Connecticut Health Policy website or email the group here, or check out this site.