Banks do it. As do libraries. Even the local grocer is involved. Modern medical practitioners, however, have yet to adopt an electronic system for managing their customers’ information.

“Name another industry that still keeps its records on paper. You can’t,” says Mark Bloomberg, MD, MBA, chief medical officer of WiFiMed (Maynard, Mass). “How comfortable do you feel having your health and healthcare dependent upon such an antiquated system?”

Bloomberg isn’t the only one asking this troublesome question. For roughly a decade, the National Committee for Vital and Health Statistics (NCVHS) has been working toward establishing industry-wide standards for electronic health records (EHRs), specifically analyzing “issues related to the adoption of uniform data standards for patient medical record information and the electronic exchange of such information”-a duty the NCVHS was tasked with via the Health Insurance Portability and Accountability Act of 1996 (HIPAA).1

Though not a new initiative, many in the industry believe the momentum is finally reaching its apex.

“Right now, there are significant numbers of things [pushing EHRs forward],” says Joel Goldwein, MD, VP of medical affairs at IMPAC Medical Systems (Mountain View, Calif). “I think they’re going to ignite [into a] much quicker adoption of EHR [in the United States].”

The biggest catalyst for the latest surge of attention to EHRs can be largely credited to government involvement at the highest level. On April 27, 2004, President George W. Bush issued an executive order calling for “the development of an interoperable health information technology infrastructure to improve the quality and efficiency of healthcare.” The goal is to make EHRs a reality for the majority of Americans within the next 10 years.2

While still in its infancy-and without such platform-building essentials as standardized systems, processes, and forms-there is no question that bringing patient records into the 21st century will have a substantial impact.

In addition to streamlining the healthcare process, estimates are that a “national health information network can save about $140 billion per year through improved care and reduced duplication of medical tests.”3

The first step to reaching this goal is an industry-wide conversion from paper files to EHRs (also called electronic medical records, or EMRs) as the industry standard for both public and private medical practitioners. This feat is particularly daunting, considering that as recently as 2 years ago, only 13% of hospitals and 14%?28% of physicians’ practices had implemented EHRs.4

How We Got Here

From an outside perspective, it seems odd that healthcare lags so far behind other industries in building a cohesive electronic network. But aside from the diversity inherent to America’s large independent provider system, a recent report from the Department of Health and Human Services5 observes “a previous lack of cohesive federal policies supporting” such an initiative.

However, the chief hurdle just might be the lack of resources-both in manpower and dollars-along with a perceived lack of a solid return on investment (ROI).

“You’ll hit your ROI break-even point faster as a larger environment that does more imaging,” says Terry Michaelson, director of technical systems for the Department of Radiation Therapy and Radiation Oncology in the Radiation Medicine Program at the Princess Margaret Hospital, University Health Network (Toronto). “The cost per image is less in a digital environment once you’re past the initial investment, but if you’re not doing as many images, it’ll take you longer [to get there].”

Often, achieving ROI isn’t as elusive as it seems, taking into consideration savings found in all areas that benefit from innovation, including those lacking specific dollar values.

“You have to balance against the cost of your preexisting system, [including] either the lost charges or charges [you couldn’t track] because the scheduling wasn’t efficient,” Goldwein says. “Or perhaps [it’s the prevention of future] errors in the treatment of patients that you can’t put a price on.”

Additionally, most facilities discover after converting that their EHR system brings with it a myriad of other perks.

“What is the dollar benefit of being able to access the information from anywhere? Or to work from home? And what is the [cost of] losing physical images and documents in a disaster?” Michaelson asks. “For those things, there isn’t a set dollar amount.”

In addition to those less-obvious assets, one of the most evident benefits is the ease of access to patient files, even remotely. A huge benefit for physicians, the appeal of this “anywhere access” isn’t lost on the rest of the staff.

“[Our] document imaging and management system makes it possible to find a chart with a click of a mouse from any workstation,” says Susan R. Miller, RN, FACMPE, administrator of Family Practice Associates of Lexington (Lexington, Ky). “[Documents are] easier to find, and quicker to file and store. The process was so much more efficient that our overhead has decreased by 6 percent since [installing it].”

For many, the time saved by no longer having to seek, update, and file paper copies is the most important improvement that EHRs bring. Staff members spend less time in the file room and more time with the patients. These savings also can help practitioners increase their workforce.

“The real return comes with efficiencies that are created,” says Tracie Ellis, manager of EMR sales for Misys Healthcare Medical Software Systems (Raleigh, NC). “[Offices] can add revenue-generating staff, such as physicians and physician assistants, without having to add any ancillary staff.”

Additional revenue also can be found in the rooms emptied of rows of metal cabinets and folders. When files are stored and processed electronically, freed-up space can easily be converted into another area to examine and/or treat patients.

Improved Workflow Means
Improved Patient Care

Generally speaking, a phone call to the doctor’s office sets off a chain of time-intensive events. The message is taken, entered, and printed in the records room, where the file is located, pulled, and updated. The entire package is then delivered to the physician, awaiting input. EHRs eliminate this scenario entirely.

“Now, when the phone rings, we go into the actual medical record, type in the message, and electronically send [it] directly to the doctor’s workstation,” says John Somers, CPA, COO of Bristol Park Medical Management LP (Santa Ana, Calif). “The physician can then log the notes [right] into the computer.”

In this way, patient records are updated in real time, creating an accurate and complete file for the next physician-whether it’s the patient’s primary physician or an ER team. Having current, accurate information empowers medical professionals to make informed decisions about what care is best for the patient.

This immediacy is one reason that widespread use of EHRs is expected to significantly reduce the total number of deaths attributed to medical errors. The file not only includes up-to-the-minute information, but the contents are better organized and easier to search through.

Automation creates another layer of protection for the patient by triggering alerts when necessary. For example, if a prescription is inadvertently written for a medication to which the patient has an allergy, a message will appear that notes the conflict. Errors can be avoided in less obvious ways as well.

“[EHRs] linked to the treatment machines reduce errors by not allowing you to enter one more zero, for example,” Goldwein says. “It can be a simple thing, but [something as minor as limiting] the field width can constrain you from doing things you could have done accidentally on paper.”

In addition to safer treatment, an electronic database of patient information provides physicians with a perspective previously impossible to gain.

“You can obtain a lot of quantitative data [using this type of system]. You’re able to really begin to know your practice, how you take care of your patient,” Miller notes. “You can do more prevention- and management-type activities with a true EMR.”

A Global Effort

The United States is not alone in placing a high priority on implementing an electronic records system.

“The United Kingdom has mounted a national effort to install EHRs in medical practices and hospitals,” Bloomberg says. “[The country] recently announced a dramatic initiative to improve the quality of healthcare, and EHRs are central to this project.”

America’s neighbor to the north also is benefiting from significant government promotion to modernize its healthcare system.

“In Canada, there’s a federal initiative and provincial initiatives to set up health networks that will [create a system] where patient information can be shared between healthcare providers in a secure manner,” Michaelson says. “Every jurisdiction is doing this.”

Making the Move

Ultimately, the question isn’t if a practitioner should convert, but when. Boiled down to the essentials, the answer is simple.

“Today is the best time to convert,” Miller says. “Once you’ve done research and understand what you’re trying to achieve, select the product that meets those needs. Then, just do it.”

For most businesses, it’s never an ideal time for a vast change to process and workflow. But in the world of technology, the longer the wait, the harder it becomes. To make the transition a successful one, it’s imperative to get everyone on board with the idea-from the physicians on down.

“All stakeholders should feel that they’re involved in converting to an electronic environment and that they have a vested interest in making it work,” says Michaelson.

Regardless of when or how the project is tackled, technology will inevitably change the face of medicine, just as it has transformed virtually every other aspect of daily life.

“Patients are coming in having surfed the ‘Net for information about their diseases and expect their physician to be [just] as comfortable with these types of things,” Goldwein says. “Technology is becoming part of medicine.”

Bloomberg concurs and poses the question, “How different is your banking today compared to 10 years ago? That’s the type of advance we’re talking about.”

The advances are predicted to bring with them a future where patients email their physicians, make appointments through the practice’s Web site, and check their lab results online. Long overdue to some and unthinkable to others, such changes are only a matter of time. And as is the case with any paradigm shift, once the dust has settled, reverting isn’t a desired option.

“After [people have] the new system, if you ask them to switch back, they won’t do it,” Michaelson asserts. “They see [the paper system] for what it is-a ?flint and bearskin’ solution for something that is better handled with 21st-century technology.”

Dana Hinesly is a contributing writer for Medical Imaging.


  1. US Department of Health and Human Services Public Law 104-191. August 21, 1996. Available at: . Accessed January 12, 2005.
  2. The White House News & Policies. Executive Order 13335. April 27, 2004. Available at: . Accessed January 5, 2005.
  3. US Department of Health and Human Services Administration on Aging. Secretary Thompson, seeking fastest possible results, names first health information technology coordinator. May 6, 2004. Available at: . Accessed January 5, 2005.
  4. The decade of health information technology: delivering consumer-centric and information-rich health care. Spring 2004. Available at: . Accessed January 12, 2005.
  5. United States Department of Health & Human Services Fact Sheet. July 21, 2004. Available at: . Accessed January 12, 2005.