In the spring of 2004, President Bush called on hospitals and doctors to drop their clipboards and go digital. He ridiculed prescriptions scribbled in Latin as relics of the horse and buggy era. And the president appointed a national health information technology coordinator to create a nationwide network of electronic health records. And today, even with reservations about security and privacy, information technology is one of the few key changes in healthcare that has nearly universal support.
But doctors and hospitals still aren't quite buying it, literally. They balk at the up-front cost of computerization. Today, only 5 percent of the nation's 800,000 doctors and only 10 percent of its hospitals have adopted electronic medical record systems.
Northeast Ohio, led by the Cleveland Clinic, has been in the vanguard. President Obama has lauded the Clinic's technology as something that could cut cost and improve care.
Dr. Ken Goodman, a Cleveland Clinic family practitioner, demonstrated the Clinic's systems with three simple clicks.
"It brings up the patient's age, race, all their past medical problems," he said. "It'll bring in their medication history, their vital signs, everything I need."
The Clinic provides its electronic medical-record system to salaried doctors, like Goodman, free of charge. But the technology isn't so easy for private practitioners. The investment of time and money holds many back.
That may change in 2011 when the Obama administration starts helping doctors make the initial investment, by reimbursing up to $44,000 per practice.
Life saving communication?
Supporters say the incentive for electronic records is more than money. It's better care.
Bill Brahler of the small town of Perry in Lake County has hypertension. Every morning he takes his blood pressure using a portable device that sends the readings to his doctor, via the Internet. Today, its high - 146 over 102 - but he's not worried.
"I know that somebody's watching me all the time," said Brahler, "and I know that they're actually calling if there's a problem. So it makes me feel secure."
Antonette Louden is a mother who lives in Brooklyn - when she's not at Cleveland's Rainbow Babies and Children's Hospital. Her sense of security is tied to the electronic monitoring of her tiny daughter, Elinore.
Born prematurely, Elinore requires dedicated care at the newborn intensive care unit at Rainbow Babies. The video camera on her daughter's crib pick up Elinore's every whimper.
The longer-term goal is to allow the sight and sounds to stretch even further, via the Internet.
If that happened, Louden said, "Then I wouldn't have to worry about being here 24-7. I could go home and get some stuff done. It would be nice."
It's the same fiber-optic network the Clinic uses to keep records that helps doctors monitor patients in real time. Ann Reitenbach, clinical manager of the intensive care unit, said that Rainbow is outfitted with video and audio surveillance that improves care. Next year, the hospital hopes to put its live baby-camera feed on the Internet, to help parents like Louden.
Dr. Michele Walsh acknowledges that the expense of technology is a concern. But the Rainbow neonatal medical director says the systems being developed by hospitals today will mean better coordination in the long term.
One drawback now, though, is that systems are being developed individually, and many can't communicate with each other. Another concern is security.
Both federal and state initiatives are trying to standardize health information technology.
The U.S. Department of Health and Human Services is working with professionals like Cleveland Clinic Chief Information Officer Dr. C. Martin Harris to prevent security breaches and computer errors. He serves on an HHS panel establishing national standards and he says the coordination of systems is a top priority.
"Fixing the challenge of interoperability is clinically important," he says. "Not just technically important."
Concern about confidentiality
Case Western Reserve University law and bioethics professor Sharonna Hoffman has just published a report that details liability risks for health-care providers as well as patients. She says no electronic record is completely secure from mishaps or security threats. And her report questions whether going digital would actually reduce costs.
"If this, in fact, eliminates mistakes, then medical malpractice costs could go down," Hoffman said. "If we get more mistakes medical malpractice, insurance costs could rise. So the issue is one of the things that we argue for is regulation and quality control of these systems. Because right now, there's no federal regulation over these systems."
According to Scot Silverstein, a consultant in medical informatics at Drexel University, medical records technology already has experienced bugs and breakdowns, "some of which rise to the level of actually causing patient harm. ... For example, causing a medication order to be altered due to a programming effect."
Health information technology initiatives are also underway in the private sector. The insurance company, Medical Mutual, hopes to provide personal health records to 1.6 million members, and spokeswoman Paula Sowers said privacy shouldn't be a concern.
"I could build my personal health record as a Medical Mutual member and I could say I don't want Medical Mutual to see the data, or I want my primary-care physician to see the data, but I don't want my mental health physician to see the data. You are the owner of that."
Miles of lines of communication
Linking health systems across Ohio requires regional fiber-optic broadband networks like the one Mark Ansbury's company OneCommunity is stringing up in Northeast Ohio. A private non-profit, OneCommunity, has an $11 million grant from the FCC to make those connections.
The plan is to link not only urban centers of Cleveland, Akron, and Youngstown, but also to connect rural hospitals in 22 Ohio counties. Ansboury said the network will "facilitate the ability for them to do health information exchange, telemedicine, and promote higher quality health care services out in the rural communities."
Through the OneCommunity link, Rainbow neonatal specialists like Dr. Michele Walsh can practice telemedicine with East Liverpool City Hospital, Coshocton County Memorial Hospital and 19 other rural medical centers. The technology saves time and unnecessary trips to the doctor.
"I can say to them, 'Oh yes I've seen that rash before. It's not a problem,'" Walsh said. "'We can see the baby as an outpatient in two or four weeks.' Mom and the baby can stay together and I think that's the biggest promise, is providing two-way support to practitioners so that we can keep moms and babies together."
But confidence among medical providers isn't all that's needed. Patients must have faith, too. And some, like Akron native Diane Woods, acknowledge they're skeptical.
"What happens when the electricity dies? I know it's the 21st century and we're supposed to be like all involved in electronics but there's something to be said about writing things down."
Text: Morgan Marucco | 
