An Rx for Paperwork : Hospitals Slowly Discover That Computers Can Be Good Medicine

At St. John’s Regional Medical Center in Oxnard, doctors seeking a patient’s test results need only tap into a computer. Nurses at the 230-bed facility review a computer file for the latest doctors’ orders and updates on medications.

And, as patients recuperate, their electronic chart includes key medical data summarized in the space of a single computer screen.

But St. John’s is an anomaly in the world of medicine, where the old-fashioned, handwritten patient chart coexists with MRI, CAT, blood analysis and other high-tech machines.

Ironically, while modern medicine spends billions on technology to diagnose illnesses and treat patients, hospitals rely mainly on mountains of paper--often with illegible scribblings--to communicate vital information.

“It all happens in little pieces of paper sitting in peoples’ pockets, all at enormous expense,” said Dr. Ralph Korpman, chief executive of Health Data Sciences Corp., a San Bernardino health information company. “It’s as if the modern financial institutions still used ledger cards.”

Increasingly, health care experts are recognizing that the paper deluge may be bad medicine. Keeping handwritten charts, they say, creates work redundancy, takes time away from patient care and may contribute to errors, such as inappropriate administration of drugs. Moreover, many agree that the pen and paper system is a costly practice responsible for a significant portion of the nation’s annual $900-billion health care bill.

Still, only about 5% of the nation’s approximately 6,600 hospitals have computer systems that fully track patient care.

Though the Clinton Administration’s health care reform package includes measures to facilitate electronic claims processing, the proposals are projected to save only about $2 billion to $10 billion annually.

However, using computers to store clinical data could save from $18 billion to $30 billion a year, according to estimates by the Arthur D. Little research firm and the Health Industry Manufacturers Assn.

“The stuff you read about a claims card and standardizing claims processing is really small potatoes compared to the savings in computerizing clinical data,” said Melville Hodge, a director of the Atlanta-based TDS Health Care Systems Corp., a provider of health information systems. Health care experts say the Administration’s reforms would speed up the move to electronic records. Under the proposed system of “managed competition,” health care providers will be forced to be more efficient and to have an easily accessible patient care database to negotiate contracts.

“They can’t afford to worry about file folders of paper moving across hundreds of square miles,” said Hodge.

In anticipation of this, the National Health Foundation hopes to launch a two-year pilot study soon to develop a system linking selected California health care providers in a statewide network.

Called the Health Care Data Interchange Network, the goal of the $17.8-million project is to create “a seamless, fluid, open system for gathering, processing and accessing patient data.”

Many health care professionals favor computerized patient charts because the current system forces them to spend too much time on paperwork--often writing down the same information repeatedly--and because the retrieval of information from reams of paper is cumbersome.

“If the doctor doesn’t have immediate access to the tests done last week, or six months ago, they’ll prescribe the tests again,” said Ash Dave, vice president of information systems at Cedars-Sinai Hospital.

That, of course, creates still more paperwork. According to studies, physicians spend up to one-third of their time attending to clerical functions; nurses can devote up to half their shifts to paperwork.

Experts note that computerized patient data systems can be designed to help determine treatment and eliminate errors.

“Flip through a medical record (and) if you believe that a physician can synthesize all the information and come up with the best possible care for a patient, you’re crazy,” says Jayne Bull, chief operating officer at St. John’s in Oxnard.

At Latter-day Saints Hospital in Salt Lake City, a system filled with five years’ worth of patient histories has determined the best time to give antibiotics to patients after surgery. Consequently, the number of postoperative infections has dropped by 27 cases yearly, saving the hospital $400,000 in treatment costs.

Still, health information systems are not cheap, nor are they flawless.

Hospital administrators say that introducing a computer system can be difficult for people used to working with pen and paper. Others worry about breaches of computer security.

Yet for hospitals with systems in place, the computer revolution has been a welcome one. At St. John’s, the new computer system has eliminated and streamlined many tasks, said Mary McGill, who manages the hospital’s intensive care and critical care units.

The hospital has not calculated its savings from the new system and the staff is still adjusting to the computers, but hospital officials say they are committed to the technology.

Says McGill: “Eventually our goal is to get rid of all the paper.”