by Mary Ann Azevedo
Houston Business Journal

Government pressure is prodding Houston-area hospitals to spend millions on going electronic with medical records.

The federal government pays almost half of all health care claims through Medicare and Medicaid, and is primarily pushing the value of going paperless.

President George W. Bush set the tone early last year by calling on doctors and hospitals to move medical records from filing cabinets to electronic files for the purpose of cutting costs and saving lives.

Last month, the Texas Medical Association chimed in by calling for a comprehensive health care information technology plan throughout the Lone Star State.

Former TMA President Dr. Robert T. Gunby Jr. echoed President Bush in saying that integrating electronic medical records (EMRs) in all physician practices would cost less money and save more lives.

As of June, just 27 percent of Texas physicians surveyed by TMA and TMF Health Quality Institute had initiated steps to implement the new technology in their practices.

EMR advocates cite benefits such as improved patient care and safety, streamlined operations and elimination of illegible handwriting.

Opponents raise questions about patient privacy issues, and whether the potential benefits will justify the actual costs.

The economic impact on individual doctors is substantial. The software cost is as much as $100,000 for making the transformation to EMRs (see related story).

The price is already high and going even higher for medical systems. More than $110 million has been committed by three systems alone:

* Texas Children’s Hospital is spending $60 million over five years.
* The Methodist Hospital is spending $43 million over eight years.
* Baylor College of Medicine has spent $10 million to date.

Others won’t disclose financial impact, but all major institutions in the Texas Medical Center are taking different approaches in various stages to enter the age of EMRs.
Texas Children’s Hospital

Texas Children’s Hospital has signed a five-year, $60 million contract with Epic Systems Corp. to install a fully integrated electronic medical record system that will eliminate paper-based charts.

Verona, Wis.-based Epic Systems will provide software for single-patient records. The agreement signed on May 18 consists of seven stages. Installation is targeted to begin this year for completion in 2010.

David Finn, Texas Children’s vice president, says in addition to being expensive the switch “will result in cultural and organizational process changes taking place.”

A single electronic record will capture all the data clinicians need to make faster and better decisions about a child’s care, says Finn.

He says Texas Children’s is treating it “like a building” for budgeting purposes.

Says Finn: “We’re considering this a capital project that is really part of an expansion of our health care services. Except that it’s not bricks and mortar. It’s the building within the building.”
M.D. Anderson Cancer Center

The University of Texas M.D. Anderson Cancer Center has taken an unorthodox approach to EMR with development of a proprietary system.

The institution developed an in-house product about five years ago used largely by radiology faculty “since images are very important in cancer diagnosis,” says Lynn Vogel, chief information officer for M.D. Anderson.

Now the product is being used by every physician, Vogel says, and the hospital is using it as a platform to build a fully interactive EMR capability.

The institution sought a system that could be used for both research and clinical purposes.

Vogel says M.D. Anderson faced a challenge because no commercial product could be found in the market that incorporated both research and clinical data. So the hospital created one.

“It is a bit more expensive than if we had purchased a commercial product, but the trade is that product would not fit the way we practice,” says Vogel.

The product won’t be for sale to others once the system is completely operative in the next 18 to 24 months.

Says Vogel: “Other people have tried to develop their own in-house system, but the labor was so horrendous, most gave up.”
The Methodist Hospital

In June, The Methodist Hospital System unveiled plans for implementing an EMR system at all four hospitals.

About 4,000 physicians, nurses and staff have been trained, and thousands more will learn the system called Methodist Online Documentation (MethOD).

Jerry Vuchak, Methodist’s vice president, says the unique system has been implemented across-the-board “as opposed to rolling it out one unit at a time like other hospitals and health care systems are doing.”

It will set the system back at least $43 million over an eight-year period, according to Vuchak.

Some Methodist staffers say the new system already is overwhelming. Hospital officials say a transition period with a learning curve was expected.

Physicians, nurses and staff in all patient areas have access to the program at all times.

Methodist’s flagship location in the Texas Medical Center and the Sugar Land hospital went from paper to electronic on March 28.

The program is scheduled to be rolled out at Methodist Willowbrook and San Jacinto Methodist. The technology also has been integrated into Methodist’s pharmacy system.

Dr. Toby Samo, an infectious disease doctor who helped design and implement the new system, believes electronic medical records are the future of health care.

Personally, he says, the new system has already improved his efficiency because he is able to be more accurate with records.
Baylor College of Medicine

Baylor implemented a form of electronic medical records in 1999.

Dr. Jeffrey Steinbauer, medical director of Baylor’s new adult ambulatory care center, says the move took place in pediatrics, family medicine, breast cancer, pulmonary and obstetrics/gynecology departments.

That program has expanded over time and the college is currently “making electronic medical records the standard in our new ambulatory care clinic,” Steinbauer says.

Since opening the adult care center last summer, Baylor has implemented electronic medical records in all internal medicine departments.

The institution is now working to implement a new EMR system in general surgery, orthopedics and urology units.

All of the clinic’s departments will be on EMR over the next 12 months, says Steinbauer, who estimates the cost so far to be in the $10 million range.

“Increasingly, control of health care will be in the hands of the patient,” he notes. “This is just one way that will happen.”
St. Luke’s Episcopal Hospital

St. Luke’s Episcopal Hospital has been implementing various parts of an electronic medical record system since 1999.

“It’s really been a journey,” says Kay Carr, St. Luke’s chief information officer.

Carr, who expects the system to be complete by the end of 2007 or middle of 2008, cites a combination of challenges along the way.

“People typically have a vision before the technology actually gets there,” she says. “Because the technology certainly wasn’t there in 1999.”

As a result, St. Luke’s has had to deal with one foot in the electronic world and the other in the paper world.

Initially, the system focused on bar-coded medicated administration, a nursing documentation system. That has evolved over time.

While Carr declines to disclose the specific investment in an EMR system, she describes it as “a significant long-term” amount.
Memorial Hermann Healthcare System

All Memorial Hermann hospitals have one electronic medical record system, says Dr. Robert Murphy, medical director of information systems.

The project called Care4 was launched in 2000 and has been a multi-year staged process.

So far, programs involve nursing and bar-coding for patients.

A third phase starting this fall will allow doctors and nurses to do all their progress notes and documentation electronically

Physicians doing their own electronic order entry “is considered the Holy Grail for EMR,” says Murphy.

“It is the most difficult from the change perspective, but it also brings the highest value in terms of patient safety,” he notes.

The third phase will first be implemented in Memorial Hermann’s new hospitals in Sugar Land and Katy, which are set to open by December.

“We’re trying to open them as digital hospitals,” Murphy says.

The system will then begin a sequential rollout to other hospitals starting in 2007.
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