Electronic medical record forms foundation of digital healthcare

Changes in the way medicine is practiced are imminent, and the increasing costs of care are driving those changes. One way to meet the challenge head-on is to move to a fully automated healthcare system, starting with the electronic medical record, according to SCAR keynote speaker Dr. Leo F. Black.

Black, retired CEO of the Mayo Clinic in Jacksonville, FL, opened the SCAR meeting in Vancouver, British Columbia, with a narrative of his own clinic's long and arduous journey to digital automation. The clinic determined to improve service to patients, increase efficiency, and decrease costs by implementing an electronic medical record in 1992.

"We decided then to devote our energy to putting all of our clinical information into an electronic format," he said.

Once that information had been digitized into one large database, various software programs that could extract information for particular needs would be overlaid on the data.

Implementation was far from easy, Black said. The hospital system, with an outpatient center and three primary clinics, is still putting the final touches on its digital automation process.

Automation of the outpatient clinic and primary-care facilities was completed in 1996, but momentum slowed in 2000 as the hospital redirected its efforts toward handling a major move and the potential Y2K problem.

Momentum is an integral part of moving to healthcare automation, according to Black.

"If you slow down, people start jumping from the canoe," he said.

Another major challenge for hospital automation is the amount of behavioral change it requires from everyone involved in providing healthcare. Implementing an electronic medical record eliminates much of the support physicians have traditionally relied on, such as transcriptionists. Doctors have to become more self-contained, Black said. And as insurers and employers pay less and patients must pay more out of pocket, doctors should learn the direct cost of healthcare for their patients.

While these behavioral changes may sound painful, they are crucial, he said. Not only will they result in cost reductions (the clinic experienced up to 32% in savings as measured by internal rate of return), they will ultimately improve the quality of healthcare. Innovations such as providing kiosks throughout the hospital to give patients up-to-date schedule and billing information and visiting with patients electronically in their homes are just some of the future advances that an EMR and healthcare automation might enable.

"Physicians have to begin to be the change agents in this arena. They have to sell these changes because they will do a lot of good for a lot of people," Black said.