Martha's Vineyard Hospital begins move to electronic medical records
The Obama administration plans to spend $19 billion of stimulus money in a push to implement health care information technology in doctor's offices across the nation. As health experts debate the merits of various electronic medical record (EMR) systems and national strategies, Martha's Vineyard Hospital will benefit from technology already in use throughout the Partners HealthCare System, to which the Martha's Vineyard hospital belongs.
It is part of sweeping change that will transform the way medical care is delivered on Martha's Vineyard. The most obvious sign is the construction of a new $42 million hospital adjacent to the ground-hugging, 1974 vintage wooden building it will replace, and adjacent also to that older building's predecessor and to the Windemere Nursing and Rehabilitation Center, which opened in the 1990s.
The new hospital is expected to be completed in January. Photo by Steve Myrick
But as significant is the technological infrastructure to be installed in the new hospital. It will affect the ways in which Island physicians keep track of patients and monitor and manage their care.
Instead of relying on paper records in manila folders, Martha's Vineyard Hospital doctors will use a state-of-the-art electronic medical records (EMR) system now in use in some of the Boston area's best known hospitals that are also units of the Partners system.
Healthy partnership
The plan calls for doctors to be able to retrieve a patient's complete file electronically. The touch of a computer screen will provide access to up-to-date medical records, including test results and a patient's history, along with alerts about possible drug interactions.
On March 1, 2007, Martha's Vineyard Hospital became an affiliate of the Massachusetts General Hospital (MGH) and a member of Partners HealthCare, a nonprofit founded in 1994 by MGH and Brigham and Women's Hospital, both in Boston. Partners HealthCare includes Newton-Wellesley Hospital, North Shore Medical Center, Faulkner Hospital, McLean Hospital, and Spaulding Rehabilitation Hospital.
At the time, Tim Walsh, Martha's Vineyard Hospital chief executive, said that becoming part of MGH would enable the hospital to tap new resources and take advantage of programs and systems out of the reach of smaller medical facilities. As an example, he cited the medical information systems and technology that Partners has developed over the past decade and a half.
The Longitudinal Medical Record (LMR) is a web-based ambulatory electronic health record, certified in 2007 by the Certification Commission for Healthcare Information Technology, an independent, nonprofit organization that has been officially recognized by the federal government. The system is now used across the Partners system.
A system-wide push
On Friday, April 24, Brian Lang and Jean-Robert Laprime, members of the MGH LMR implementation and support team, described the system and its capabilities to a group of Island doctors and nurse practitioners.
In an interview with The Martha's Vineyard Times at the hospital later that morning, Mr. Lang and Mr. Laprime described the capabilities of the system they will soon begin to install. Jim Noga, MGH chief information officer, participated by telephone.
Mr. Noga said Partners has moved to implement LMR throughout its 543 medical practices, which include 705 primary care physicians and 2,100 specialists. Almost 100 percent of the primary care physicians and 85 percent of the specialists utilize LMR. All Partners physicians will be required to use the system by the end of 2009, he said.
Vineyard patients treated at hospitals within the Partners system will benefit from instant record transferability. For a Martha's Vineyard Hospital patient who moves, or seeks medical treatment outside the Partners system, a paper copy of a patient's records remain an option, Mr. Noga said.
Critics within the medical establishment argue that the push to move to EMR will lead to a lack of standardization and competing and expensive operating systems that are out of reach of smaller medical practices. Mr. Noga answers that there is no question that EMR standards are still evolving. Partners continues to stay close to those evolving standards, he said.
The timing of the nationwide push for EMR may benefit Martha's Vineyard Hospital. Money provided in the stimulus bill to accelerate EMR could provide up to 40 percent for the cost to purchase new computer equipment, Mr. Walsh said.
MGH technology specialists provided the specifications for wiring the new building, which saved on design costs and ensured that the hospital will be smoothly linked electronically to Partners.
"We do plan on going on the Partners network when we open the new building," said Mr. Walsh.
The change from paper will not wait until moving day. Mr. Walsh said that all hospital physician offices will begin using Partners LMR before the end of the calendar year, so before moving into the new building.
At first, Island physicians would access the Partners network on their current computers through a secure Internet connection. The task of chart conversion has already begun, Mr. Walsh said.
Charts at a click
"When you start to get the flavor of the system," said Mr. Walsh. "It really does get exciting. Everyone expects the conversion part to be difficult, but once on the other side, it really will provide a significant improvement in quality."
Mr. Noga said once the system is in place, additional features will be added. He said Partners physicians have found some features to be extremely valuable.
For example, e-prescribing allows a doctor to send a prescription directly to a pharmacy. The system also alerts a doctor to any possible complications due to interactions with other drugs or patient allergies.
The system complies with federal medical record privacy laws, Mr. Noga added. Medical information can also be made available on a need-to-know basis, he said.
At the Friday morning presentation, Mr. Lang and Mr. Laprime showed a model of the LMR display, a version of which would appear on computer screens. Later, the two described some of the LMR features to The Martha's Vineyard Times. A touch of the patient's name on a screen will bring up a basic menu display that includes a section for physician notes by date entered, medications, problems, and immunizations.
The doctor does not have to go searching for data, Mr. Laprime said. For example, if a person went to their primary care doctor after a visit to MGH, the doctor would be able to open up that patient's chart and see a complete record of that earlier visit.
When a patient sees multiple doctors, the system will also provide an alert when a prescribed medication could lead to problems arising from a medication prescribed by another office. "Multiple offices would be aware of what doctors are prescribing," said Mr. Laprime.
The system also provides information on which medications are costly and provides possible alternatives. The attending doctor may then look for less costly generic alternatives.
Mr. Laprime and Mr. Lang said that a critical element in the evolution of the LMR system has been the advice of the doctors that use the system. The information technology team meets with the doctors twice a year, they said, to review the system and share possible improvements.
Doctors are impressed
The Friday session provided a look at the future of medical record keeping for local medical providers.
"It is very impressive system," Dr. Michael Jacobs told The Martha's Vineyard Times in a telephone conversation. "I think there will be something of a steep learning curve for all of the people that are using it, but once it is in place I think it will just facilitate communication and retrieval of data regarding patients whether they have been seen in Boston or down on Martha's Vineyard."
The system will benefit both patients and doctors, said Dr. Jacobs who owns Vineyard Medical Services in Vineyard Haven. "I think to have access to other physician records, consultations, lab data and X-rays at the time that you are consulting or seeing someone makes a huge difference," he said. "And the patients don't have to coordinate their charts anymore."
Best of all, said Dr. Jacobs, the system has nothing to do with billing. "This is very much a patient-orientated record system," he said.
"I am very excited about it," said hospital surgeon Dr. Denise Fraser, who attended the Friday morning presentation. One of the hospital's two resident surgeons, she said she often sees patients who have been referred from a primary care physician. It is a process that relies on the efficient and timely transfer of medical records, including the results of recent laboratory tests.
Dr. Fraser said EMR would provide her with up-to-date information before a patient arrives in the office, so that she can be prepared when a patient does arrive. That will also result in quicker scheduling. "In essence, efficiency and accuracy will be increased," she said.
That will be true for a patient transferred to MGH or for one who returns to the Vineyard following a stay in the Boston hospital. Records that now get transmitted by fax and telephone, a process by which information can go astray, would be shared electronically and immediately.
Dr. Fraser said the new system would have an additional benefit in a profession not known for good penmanship. "This way it is legible, and I don't have to try and figure out so and so's writing," she said. "It's all on there."
The screen interface shown during the presentation looked very user friendly, Dr. Fraser said. It allows the user to click and point, or opt for a voice-activated system. "It will be a little slow gearing up, because a lot of information has to be entered," she said. "But five years from now people will asking, how did we live without this."
