(Host) Vermont lawmakers are pushing ahead with efforts to create a single payer health care system.
Many say part of the equation must include a way to better connect doctors and hospitals across the state.
But installing new electronic health records, getting providers to use them, and connecting all the different systems is a complex and costly challenge.
To see why, VPR’s Nina Keck spent time at Rutland Regional Medical Center, which launched its new 20 million dollar computerized health record system this month.
(Keck) Dr. Kurt Dufty holds a clipboard in one hand while he taps onto a computer keyboard with the other.
(Dufty) "In the emergency department we did all of our work as physicians and nurses on this clipboard – so now what we do is we have this clipboard as our security blanket – but the work is all done on this computer screen."
(Keck) Dufty heads up the emergency department at Rutland Regional Medical Center. He says for years, the ER relied on paper and a big erasable white board that listed patients and their conditions. Now there’s a 65-inch plasma screen on the wall and Dufty accesses information with the click of a mouse.
(Dufty) "Right in front of me as a physician I see a patient’s name, I can identify their allergies and at the same time I can identify if they have any medications that are active. "
(Keck) Ideally, he can check on blood work, test results and X-rays in seconds.
(Dufty) "So I have all the information in front of me that I need to write orders where before the allergies might be on another piece of paper and the medication list might be on another piece of paper. This is a big gain for us in safety."
(Keck) But with any new system, there are glitches – information that’s not where caregivers expect, systematic steps that are cumbersome or confusing. There’s been a lot of cursing, Dufty admits.
(Dufty) "It’s extraordinarily stressful – It takes a lot of belief because it’s not a video game we’re actually providing care so that when I click on an order, I need to believe that it goes to the right place, that its going to come back to me. It’s a trust thing."
(Keck) It’s also an incredibly complex and costly thing. Hospital President Tom Huebner says work on the transition began three years ago when they began shopping for a system. Once they found one they liked, Huebner says they had to customize the programming for every hospital department.
Head Pharmacist Ji Chen says the new paperless system does a much better job of cross-checking for dangerous drug interactions. And she says clinical information is much easier to get.
(Chen) "We used to have multiple different systems. They don’t talk to each other. So it was very cumbersome to find the information that we need to do the daily work. Right now everything is in one documentation."
(Keck) An even bigger plus says Chen is not having to decipher physicians’ handwriting. But while some are embracing the new technology, many at the hospital argue that the stress of learning the new system, while carrying a regular workload, is causing big delays and taking away from their ability to focus on patients. Tom Huebner nods.
(Huenber) "A doctor said to me this morning, ‘You’re asking me to change the work processes that have worked so well for me for 20 years and I don’t like it.’ He’s right. That’s exactly what we’re asking."
(Keck) But it’s worth the effort, says Huebner, because patient safety and outcomes should improve and data collected with the new system will allow them to better track hospital care. The technology will also make the hospital eligible for federal and state incentive payments – a huge benefit.
Still, a big part of the appeal of these costly systems, faster and better communication between a variety of health care providers, is still more dream than reality once you get outside the hospital.
(Huebner) "There are pieces of information that are now being shared with providers – mostly around lab results and radiology results. That is going to get richer and deeper as the years go on. You don’t turn it on and suddenly it’s all there. "
(Keck) That’s where VITL comes in, which stands for Vermont information Technology Leaders.
It’s a nonprofit organization that’s helping hospitals and doctor’s offices in the state better utilize electronic health records.
They’re also creating a data exchange that will allow all the various systems to talk to one another.
By law, every hospital in the state must have an EHR system in place and be connected to VITL by July 2012. Nearly all primary care practices in the state are expected to be on line the following year.
For VPR News, I’m Nina Keck in Rutland.