In 2004, President George W. Bush set a 2014 goal for most American doctors to be using electronic medical record (EMR) systems to share lab results, images, computerized orders and prescription information with hospitals and other health facilities.
While industry estimates indicate only 20 percent of doctors nationwide have met those standards (many are still faxing), the chief executives of an Oklahoma City-based community health center and local anesthesiology practice, along with national observers, agree that process improvements must accompany EMR for true health care reform.
“If you just computerize a bad process, you've got a bad problem,” said Keley John Booth, founder and president of Advanced Perioperative Services anesthesiology practice.
Booth, using a service/software product from his recently formed Surgical Logistics consulting group, brought the on-time starts at surgeries at Integris Southwest Medical Center from 35 percent to 75 percent and cut surgery staff costs by 10 percent, creating the effect of adding an additional operating room.
His solution is to combine lean manufacturing principles with technology integration.
“You need to learn the process, map the workflow,” Booth said, “from room utilization, management of resources such as X-ray equipment in the operating room, how patients get from one area to the next, and the predictability of the OR (operating room) schedule.
“You don't have to spend $1 million dollars to get efficiency. You need to get the right people asking the right questions, with the appropriate support.”
Booth and his team of nurses, surgical technologists, operating room schedulers and financial consultants initially set out to reduce turnover time between surgeries, and realized they instead needed to focus on everything else. They started by following a patient through the surgical process to experience it through the patient's perspective. What they found was too many phone calls between the front desk, operating room, registration and other departments, with questions as simple as, “Is the patient in the building?”
“No one comes to the hospital to sit and wait for longer than needed, or spell their name four different times,” Booth said. “They come to get patient care, as fast and efficiently as possible so that they have more face-to-face time with their doctor.”
Booth believes hospitals' and clinicians' conversion to electronic medical records, which supposedly is required by 2014 to receive Medicare reimbursements, is a small piece of reform.
“You could wear a USB stick around your neck with a patient's complete record, but if there's no time to read it, what good does that do?” he said.
By 2014, when most Americans will be required to have insurance or pay a penalty, observers predict the number of patients will grow by 40 million.
“We have to improve delivery now so that we can care for those additional people — and cut the waste in operations, which is passed down to all of us as individuals,” Booth said.
Working from office space in the Moore Norman Technology Business incubator, Booth and colleagues are in talks with hospital networks in Oklahoma and contiguous states about contracting his consulting service and software product. He's also working with the Philadelphia-based RFID (radio-frequency identification) in Healthcare Consortium toward integrating his product with technology from a variety of vendors.
Like the car window stickers used for quick pay of turnpike tolls, RFID technology uses radio waves to identify, track and store electronic information on objects that have microchips, including tiny antennas, embedded or attached to them.
“RFID is having a tremendous impact on health care,” said Harry Pappas, founder and chief executive of RFID in Healthcare. Microchips, he said, are being embedded in everything from artificial hips, heart and hospital identification bracelets to wheelchairs, infusion pumps and bags of blood.
“It may cost millions to do, but you quickly get your return on investment,” Pappas said.
For example, chips now are being embedded in surgical sponges, he said. RFID technology, he said, saves much time counting and recounting sponges and other instruments, to ensure they're not inadvertently left in a patient's body before incisions are closed.
Variety Care, which operates 13 community health centers across Oklahoma County and in three western Oklahoma towns, converted its scheduling, billing and patient information from paper to electronic records in 2009, CEO Lou Carmichael said.
“It undoubtedly has improved the quality of care,” Carmichael said. “You never lose a chart; charts are always there, and doctors can pull them up on their laptops to consult patients' meds and health history, when they take after-all calls.”
But the health care industry won't see the real value of electronic records, until the whole system is connected, Carmichael said. Then, Variety Care providers, for example, could see the details of a patient's last visit to the emergency room or cardiologist, or the results of his blood tests at a free clinic across town, she said.
Meanwhile, Carmichael and other managers are focusing on process improvement, including triaging pediatric patients on the phone calls with parents to make sure patients' needs can't be treated without an office visit — and extending clinic hours until 9 p.m. to make the greatest use of facilities and treat more patients.
Carmichael's biggest concern regarding health care reform is access.
“Just because more people will have coverage — whether through policies bought in new insurance marketplaces or the sharp expansion of the state-federal Medicaid program to include adults without dependent children — “doesn't mean they'll have access to care,” she said.
More and more doctors aren't treating patients with Medicaid or Medicare, Carmichael said.
“Since health care reform was passed, the focus has evolved to insurance reform,” she said, “But we need to get back to what the law is about, and that's access to primary care.”