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Tri-Cities region among nation's leaders for digitizing medical records

Sharon Hayes • Apr 24, 2009 at 12:00 AM

KINGSPORT — Thousands of patient files lining the walls of physician offices throughout the nation may soon disappear as part of a plan to digitize the nation’s medical records.

And the Tri-Cities region is at the forefront of the effort.

Earlier this year President Obama announced he wanted to computerize the nation’s medical records within five years as part of a plan to reform healthcare. Some $19 billion was dedicated for the new technology in the economic stimulus plan to help providers go digital.

It’s an ambitious goal. Today, less than 2 percent of hospitals use electronic medical records in all departments and only 17 percent of doctors have access to digital systems, according to studies published in The New England Journal of Medicine.

The Obama administration believes that digitizing healthcare will save the government $12 billion in 10 years because it would reduce duplication of tests and help prevent medical errors.

Healthcare providers face penalties beginning in 2015 if they haven’t joined the digital bandwagon.

Locally, this region is ahead of the digital curve, led by CareSpark and Holston Medical Group.

Holston Medical Group

As the founder and president of Holston Medical Group, Dr. Jerry Miller began converting all patient files to electronic medical records 13 years ago.

He says it’s one of the best decisions he’s ever made.

Today, all offices of Holston Medical Group are connected to one another and all physicians are able to pull up patient records with the click of a mouse.

The system makes HMG offices more efficient and cost effective, reducing duplication of services and resulting in less errors than paper charts, Miller said.

“We have 281,000 patient charts and we see almost 50,000 patients a month and all of those records are in there. You can see what happened on the last visit or 10 years ago,” Miller said.

Miller began practicing medicine in 1966, at a time when electronic medical records were unheard of.

In 1977, he formed Holston Medical Group with a goal of modernizing the region’s healthcare and making it more efficient. And converting to electronic medical records was eventually part of that process.

Miller said the conversion meant a lot of work and a lot of expense, but the investment paid off.

Today, HMG — a large, multi-specialty practice of more than 100 physicians — saves more than $800,000 a year in transcription costs alone. And Miller travels around the country speaking about the conversion and what it’s meant to HMG.

Miller just returned from a meeting in Arizona where he spoke with 150 medical groups on the subject.

“Of all the groups that were there, we were more advanced, more sophisticated, more emulated than any of them,” Miller said. “It is modern healthcare and it’s the thing we’ve got to do. I’m proud of where we are.”


CareSpark is another regional asset in the effort to digitize patient records. Established in 2005, CareSpark is a Regional Health Information Organization (RHIO) based in Kingsport and covering 17 counties in Southwestern Virginia and Northeastern Tennessee. The organization operates servers located at OnePartner ATAC (Advanced Technology and Application Center), a corporation formed in Duffield by Holston Medical Group in 2006. Those servers contain a master patient index with access to thousands of medical records from patients across the region.

“Just to have an electronic health record is not enough. They need to be connected to talk to each other,” said CareSpark Executive Director Liesa Jenkins.

“That’s what CareSpark really focused on initially — putting infrastructure in place that would allow different systems to talk to each other.”

Today, about 1,200 physicians are connected through the CareSpark network. And Jenkins’ top priority is helping other healthcare providers incorporate electronic medical records filing into their systems to participate in CareSpark.

She’s also hoping to build a clinical data repository that would collect data and analyze it to show what methods are working to improve the region’s collective health.

“We’re in this information age. We’ve figured out how to get the information, and I think what we’re looking at is an explosion of how to use the information,” Jenkins said.

Another CareSpark priority is engaging patients in the healthcare process, and encouraging them to take charge of their own care and be proactive in preventing disease.

And CareSpark is hoping to expand its ability to connect to other regional health information organizations across the nation.

Automating a nation’s healthcare

Jenkins said she’s encouraged that folks in Washington are placing an emphasis on health information technology and its potential for improving health and lowering the cost of care.

At Holston Medical Group, Miller said he’s “enamored” with the Obama administration’s plan to automate the system.

“The technology is already here. The problem is the politics and the political arena. It’s time we got that in shape,” Miller said.

President Obama recently signed an executive order creating the Office of Health Reform, and tapped Nancy-Ann Min DeParle to head up the effort. She’s a graduate of the University of Tennessee who served as commissioner for the Department of Human Services under Gov. Ned Ray McWherter. She also served in the Clinton Administration as administrator of the Health Care Financing Administration.

“That’s a very good thing for Tennesseans — that she’s in that position,” Jenkins said.

A national commission for certification of health information technology has also been established to set guidelines for electronic medical records systems.

In addition, the commission is developing criteria for health information exchanges like CareSpark.

Jenkins said CareSpark was recently singled out for its success at a conference on the subject. As a result, other communities from outside the region have asked CareSpark if they can join the network, instead of building their own from scratch.

And other networks are looking to tap into CareSpark and vice versa. Jenkins noted that the Virginia Department of Health is moving forward with plans to connect to CareSpark, and other states are looking to link up as well.

“What you’re seeing is a network of networks connecting together,” Jenkins said.

Security issues

Protecting a patient’s privacy is a key issue in the debate surrounding electronic medical records. Jenkins said policy makers must find a balance between protecting privacy and protecting the common good.

For instance, a patient with an infectious disease may not want that information released and shared among healthcare providers. But what if that patient works in close contact with other people?

“That could jeopardize that person’s coworkers,” Jenkins said. “So there are cases of public safety where it’s important to have that information.”

At Holston Medical Group, Miller balks at the question of security, saying electronic medical records are the most secure way to handle patient files.

“If you really want to worry about your records, you better worry about a paper chart. Doctors are notorious for taking paper charts and putting them in the trunk of their car and taking them home at night,” Miller said.

He said that before HMG implemented electronic medical records, 15 percent of patient paper charts were lost at any given time.

“To try to retrieve them on some doctor’s desk or some nurse’s desk or in the trunk of a car is just unacceptable,” Miller said.

Other challenges will have to be addressed, such as sharing patient information quickly and efficiently.

For instance, a doctor on the Tennessee side may prescribe a pain killer to a patient, not knowing that a doctor on the Virginia side prescribed the pain killer to the same patient.

The doctor would have to search through neighboring state databases to make sure the patient had not been prescribed similar drugs across the state line — a time-consuming effort that many doctors aren’t willing to make.

“Until we have the ability to do that quick and easy it’s going to be very difficult for us to address the problem of people crossing state lines to get multiple prescriptions,” Jenkins said.

She said the system could ultimately help decrease drug abuse and the number of overdoses in the region.

Salvaging the system

The idea of digitizing the nation’s medical records is not new. In 2004, George Bush announced in a State of the Union address that he wanted every American to have their medical records computerized in 10 years — by 2014.

Listening to that speech, Jenkins, who had been working on ways to improve the health of the community since 2002 as then-director of Kingsport Tomorrow, knew the region was ahead of the curve at that point in time.

A year after Bush’s speech, CareSpark was formerly established.

Since then, CareSpark has achieved national visibility as one of nine communities funded in 2004 by the Foundation for eHealth Initiatives.

In 2007, the organization was awarded a contract by the Department of Health & Human Services to participate as one of nine health information exchanges in the trial implementation of the Nationwide Health Information Network.

Jenkins said CareSpark is expected to receive some economic stimulus funding as part of Obama’s plan.

“I feel very good about CareSpark’s position to bring some of those dollars here to this region,” she said.

And she see’s CareSpark as a leader in converting the nation’s medical records to digital format.

She said one of the key issues to healthcare reform is information — and the ability to analyze the data to bring about changes in the system to impact the health of the people.

“It’s the basic capability to look at information. If you can’t do that, you can’t tell what works, you can’t tell what’s cost-effective, and you spend a lot of time and money just getting the information,” Jenkins said. “Until we have those things in place, I don’t see how you can begin to reform healthcare.”

Miller said healthcare reform cannot occur without electronic medical records.

“In my opinion, the thing that will salvage the American healthcare system for quality, access and cost is automation,” Miller said.

“And the automation must be in the way of electronic medical record and health information exchange. This is what HMG is all about. This is what CareSpark is about. It is the saving grace.”

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