This story was originally published at reesenews.org. It was co-written with Laura Montini.
If UNC-Chapel Hill graduate student Sylvia Richardson doesn’t feel well, she makes an appointment at UNC Campus Health Services. When she recently fell ill, her usual doctor wasn’t available.
Richardson had to see another practitioner, someone she didn’t know.
She was skeptical that this new doctor would be able to help her since he lacked knowledge about her personal chronic condition — something her old doctor had helped her manage.
The doctor was able to review her past medical history.
“He turned the clipboard around and let me see the screen,” Richardson said.
Just by looking at the figures from her test results, Richardson could tell that nothing was unusual.
“It was just comforting to be able to see all the way down, the history of my visits,” she said.
Improved patient and physician cooperation in managing an individual’s health care plan over time is called “continuity of care.” And it’s just one benefit that patients and doctors at UNC Hospitals and Campus Health are seeing with the use of electronic health records.
Reesenews conducted an informal survey with 46 UNC students about their experiences at Campus Health Services. Out of 35 students who said they had been to Campus Health more than once, 25 said their doctors seemed knowledgeable about their past medical history.
UNC leads transition to electronic records
With the signing of the 2009 American Recovery and Reinvestment Act, the Obama administration called for health information to go digital, claiming the change would reduce medical errors and health care costs and improve coordination of care.
The rate of adoption of electronic health record systems varies greatly across the state, but doctors at UNC Hospitals and Campus Health lead the way in implementing these systems.
“I think UNC is well ahead of the pack in many ways,” said Javed Mostafa, UNC professor of Information and Library Science.
In February, IBM and UNC launched a new health information exchange to improve doctors’ ability to access patient information across the UNC Health Care system. The exchange will streamline communication among UNC’s hospitals in Chapel Hill, Raleigh and Siler City, despite the fact that each uses a different type of electronic health record.
In some cases, doctors have been slow to adopt electronic systems. They cite high costs, limited access to training and a lack of concrete evidence justifying their usefulness.
But while there are short-term headaches associated with implementing and using electronic health records, health experts maintain that there are accompanying long-term benefits for patients and doctors.
An adjustment for some doctors
UNC medical student Sally Wood said she is comfortable working with electronic health records. But that’s after three years of working with the technology. Previously, Wood had very little experience dealing with paper records.
Doctors who have worked primarily with paper for their whole careers find that there is a learning curve to going digital.
“Working with older doctors and watching them work, it just takes them a lot longer to adjust,” Wood said.
Some doctors struggle to navigate through confusing record interfaces, leading to distractions and insufficient focus on the patient. Doctors can be overwhelmed by the amount of information on the screen, such as pop-up reminders about tests and procedures.
“I see a lot of encounters when the computer is in the room with the physician and the patient where it destroys the intimacy of the visit,” Wood said. “That said, I’ve also seen encounters where the doctor used the computer to pause to look and listen to the patient.”
Doctors interviewed for this article mentioned that a failure to adequately train the entire practice in digital record keeping will negatively affect efficiency. Struggling with the technology can make visits longer, causing doctors to see fewer patients.
Dr. Tim Carey, director of the Sheps Center for Health Services Research, successfully switched from paper to electronic records — but not without adjustment. Over time, he’s developed a work style that suits him.
To keep the lines of communication with his patients open, Carey keeps the electronic clipboard off to his side. This way, the patient is directly in his view, and it’s easier for him to show the patient what he’s looking at on the screen.
Whether doctors use paper or electronic clipboards, they will always need to record information, said Dr. Sam Cykert, associate professor of medicine at UNC and a leader in the push for state adoption of electronic health records.
“Before electronic health records, I used to take notes,” Cykert said. “Now, using a laptop, I do the same thing. I’m just typing.”
But some practices don’t want to bear the headaches of adjustment when they’re combined with the high costs of setting up an electronic system. For a small rural practice, equipment and training costs can be up to $30,000, Cykert said.
Practices have limited incentive to make the switch if they’re not assured that high price tags will result in improved care and decreased costs, said information and library science professor Javed Mostafa. Though many health experts advocate for the change, current data is speculative that electronic health records will accomplish these goals.
“There aren’t very good studies yet that very concretely and powerfully justify why practices have to change to a digital environment,” Mostafa said. “It’s not easy for me to say that, because I’m a proponent of change.”
Patients, state, could benefit from digital records
It might not be unusual for patients to see their doctors still using paper and pencils. Cykert estimates that only one-fifth of state practices have begun the process of adopting electronic record systems.
Tammy Ivins, a UNC graduate student, said her hometown doctor in rural Virginia doesn’t use electronic records. But her visits at UNC were set apart by the comfort she felt when her doctor used an electronic clipboard to enter her information.
“I felt that it was much less likely that I would either forget to tell them something or they would miss something,” Ivins said. Additionally, she said she felt reassured that her information wouldn’t get lost or forgotten in a paper file.
Even when the doctor used the clipboard, Ivins said she could tell that the focus was on her. The doctor walked Ivins through her work process, explaining exactly what she was using it for.
“Just letting me know, ‘I’m not playing Pac-Man. I’m entering this information in,’” Ivins said.
Once the doctor enters the information, they can give their patients the ability to view it from home. This is critical for patients like Sylvia Richardson who need to know the results of lab work to manage her chronic condition.
“Normally, I have to wait a long time to get them back,” Richardson said. She received the results the same day as her visit.
Richardson, who is a student of information and library science, is familiar with both the good and bad of information technology.
“I know that no security system is perfect,” she said.
One pitfall of using an online system is the potential for security breaches. A 2007 incident brought this into sharp focus when UNC’s mammography registry was hacked. The database contained information uploaded by doctors for research purposes.
At least 114,000 Social Security numbers were potentially compromised in the incident, though it’s still unclear whether that information was misused.
Because the UNC system was created in-house, its developers are experienced in the security of UNC’s patient data, Mostafa said.
“But I do say that patients always should ask, ‘What am I consenting to?’” he said. Mostafa also encourages patients to know who will be viewing their information and where it’s going.
Looking forward, all patients could benefit from the way digital records facilitate research. Electronic health records allow researchers to study the medical characteristics of large sample populations.
Mostafa said that such research is almost impossible to do now with so many patient records still on paper.
UNC’s initiative, The North Carolina Translational and Clinical Sciences, one of 55 medical research institutions working as a national biomedical research consortium, is laying the foundation for a system that would aggregate patient information for biomedical research.
Rather than sitting tucked away on a shelf, data entered into an electronic health system can be easily accessed by researchers. Their ability to draw on large amounts of population data would allow them to explore everything from surgery outcomes to the effectiveness of different medicines.
Mostafa said he is optimistic that UNC can create such a system through NC TraCS.
“A format that allows us to analyze and study populations of patients — that’s sort of a grand vision.”