STORIES FROM THE ROAD: Electronic Health Records Improving Patient Care

Janet Winberg, whose six-year old son Kyle underwent two liver transplants five years ago, described the dramatic change for the better when she was able to get access to electronic health records provided by the on-line Cincinnati Children’s Hospital Liver Portal.

“After the first liver transplant,” said Ms. Winberg, “a typical day at home from the hospital was when the nurse would come and draw his blood for his labs and I would literally sit around the house all day waiting for the results.”  When the report finally came “around suppertime,” she said, “It was hard for me to grasp what they were talking about.”

If Kyle needed to return to the hospital for an additional blood test or a biopsy, said Ms. Winberg, “I had to… scramble to make arrangements for bus transportation, the baby-sitting; my husband had to make arrangements at work so he could be with me at the hospital the next day.  And I had three older children.”

Eight months later, shortly after Kyle’s second transplant, Ms. Winberg linked up to the liver portal.  “Now on a typical day,” she said, “The nurse will come to draw blood.  Two hours later, I’m sitting in front of my computer accessing those results myself.  If I have any questions, I type them out.  The nurse can call me with the response or she can just e-mail me right back.”

The introduction of the EHR dramatically reduced the level of stress for Ms. Winberg and her family.  If a biopsy was in order, Ms. Winberg was able to plan.  In addition, she said, it also helped her become an active partner in her son’s care.  More than once she was able to spot concerns on Kyle’s online chart that made a difference in his treatment. Furthermore, she said, when the family travels, they don’t have to lug along Kyle’s hefty medical file. His records are available to any hospital through the online portal.

Alfonso Barnes, MD, a pulmonary and critical care physician and a member of a 100-member group practice, has worked with electronic health records in the office for about seven years.  He described Cincinnati metro area medical providers’ leap into the health information age, made possible by the interoperable link through the HealthBridge network.

Dr. Barnes contrasted the old system where “you’d have to go through page by page trying to find out what’s been done with the patient,” with the enhanced access to comprehensive information that’s possible with an EHR.  “When I make my rounds today,” he said, “I read the pocket PC.  I come into the hospital, I click a button, it takes about two minutes to export all of my patients on to this and I can go around and make rounds.”

Dr. Barnes described how, by simply pulling up his patient list, he had access to a wealth of information for each, individual patient without having to thumb through reams of paper. 

• This included a detailed medical history, the patient’s current condition, medications, vital signs, test results, and how well a patient tolerated a particular procedure. 

• He was able to quickly review an X-ray without having to take the time to visit radiology and request X-ray film. 

• He was able to check when screenings and immunizations are due.  He can communicate, in real time, with other doctors, and can confirm the practitioners and family members with whom he can share information.

• If he was prescribing medication, he could email the pharmacist via handheld computer to let the pharmacist know that he was aware of a possible drug interaction and that he’d made some adjustments.  Dr. Barnes could see a patient, decide to discharge the patient and, by the time the patient gets to the front of the building, the prescription could be filled and ready for pick up on the way out.

According to Dr. Barnes, no matter which hospital in town those encounters take place, they are automatically entered into office electronic medical records, giving all Cincinnati providers up-to-date patient access.

Daniel Lee Hart, a veteran in his 70s, had multiple chronic conditions including severe gout and congestive heart failure.  He needed various medications and was wheelchair-bound.  He was joined by his doctor, Peter Embi, who described how EHRs at the Veterans Administration hospital greatly facilitated coordination of care for Mr. Hart.

 “Mr. Hart was a very complex patient, and a lot to manage,” said Dr. Embi.   “Without the benefit of the electronic health record, at best his care would be slow and delayed.  I think that’s putting it mildly.”

Mr. Hart had recently moved from Iowa to Ohio and his EHR tracked with him.  This was especially important because Mr. Hart was allergic to a specific medication that could effectively treat the gout.  Because Dr. Embi had access to Mr. Hart’s records from Iowa and even prior to that, with the click of a button the doctor was able to review all of the records the first day he saw his patient.  When Dr. Embi spotted the reference to the allergy, he started the medication slowly to desensitize Mr. Hart.

Dr. Embi also stressed the importance of interoperability in coordinating care with Mr. Hart’s other specialists.  “He might actually have been harmed by some conflicting medications and certainly we wouldn’t have been able to coordinate care,” said Dr. Embi.   “Mr. Hart has got a rheumatologist who takes care of his gout; he’s got a cardiologist; he’s got a primary care practitioner that actually works at another facility in town.  All of us can all benefit from logging into the records because we work at the VA system,” the doctor said.  

The Palo Alto Medical Foundation, backed by a grant from HHS’ Agency for Health Care Research and Quality, offered a model of how electronic health records can work with its on-line diabetic management program. 

Half of all Palo Alto’s patients—approximately 100,000 individuals—have a personal health record (PHR) with their primary care physicians to monitor diabetes.  The patient inputs health information into his or her home computer and, with the click of a mouse, the data is graphed out in real time.  Two of these patients related their experiences with PHRs at the meeting.

Marlene Mariti, 68-years old, came to the Palo Alto project with a strong family history of diabetes.  Marlene said her grandmother, who had diabetes, died before her time.  Ms. Mariti’s father also suffered from diabetes.  He refused to believe he had diabetes until his legs were amputated. 

So Ms. Mariti didn’t need to be convinced that she needed to manage her condition.  Yet she had little success testing and monitoring her glucose levels on her own.   The personal health record made available with the Palo Alto program “totally changed my life,” said Ms. Mariti.  With the support of the PHR, she changed her diet, began to exercise and lost weight.  “I’m a visual learner,” she said.  Recently a cousin in Arizona who was just diagnosed with diabetes called.  This cousin wants to move to Palo Alto to get a personal health record like Ms. Mariti’s. 

Walter R. Nelson, age 70, also found the Palo Alto PHR invaluable as he took to the road in his mobile home four months out of the year.   Mr. Nelson, quoting his blood sugar and hemoglobin A1c, said he found the on-line information invaluable in enabling him to stay on top of his diabetes.  Doctors in the audience said they had never seen anyone so fluent. 

Mr. Nelson was also able to contrast his positive experience with the difficulty of not having a personal health record.  While on the road in Arizona, he noticed his wife slumping in the seat beside him.  She’d had a stroke.  Fortunately, they were able to stop at small rural hospital.  “The hospital did a great job,” said Mr. Nelson.   “But things would have been so much easier if she’d had a PHR.”

Dr. Sal AbiEzzi spoke to many of his colleagues’ reluctance to bring their offices on line with health information technology.  He hears reservations from other doctors, he said, but can’t agree. 

“This gives you your life back,” said Dr. AbiEzzi. “You get to know your patients in a way you couldn’t before; it frees up your time.  I don’t have to be at the office now, I can go to my kid’s soccer game.”  “Electronic health records have transformed my life, not just my patients’ lives,” he said.