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Commission on Systemic Interoperability
Ending the Document Game: Connecting and Transforming Your Healthcare Through Information Yechnology

E-Prescribing and Electronic Health Records

Transcript

THIS IS A SPECIAL REPORT ON E-PRESCRIBING AND ELECTRONIC HEALTH RECORDS. I'M KRIS REBILLOT REPORTING FOR THE COMMISSION ON SYSTEMIC INTEROPERABILTY.

WHILE JOKES ABOUT PHYSICIAN HANDWRITING ARE LEGENDARY — THE FACT THAT ILLIGIBLE WRITING RESULTS IN MEDICAL ERRORS IS NO LAUGHING MATTER. WHILE IT MAY TAKE YEARS FOR E-PRESCRIBING TO BRING AN END TO THE JOKES — THIS TECHNOLOGY IS PAYING OFF TODAY FOR PATIENTS AND DOCTORS FORTUNATE ENOUGH TO BE ON THE LEADING EDGE OF THE DIGITAL HEALTHCARE REVOLUTION.

BASICALLY, E-PRESCRIBING INVOLVES ENTERING A PRESCRIPTION FOR A MEDICATION INTO AN AUTOMATED DATA ENTRY SYSTEM — THEN GENERATING THAT PRESCRIPTION ELECTRONICALLY. LYLE BERKOWITZ — A PRACTITIONER IN A LARGE HOSPITAL-BASED PHYSICIAN GROUP IN CHICAGO USES E-PRESCRIBING — AS ONE FACET OF A PAPERLESS ELECTRONIC MEDICAL RECORD.

Berkowitz 1: One of the most fundamental things that we can do is have a legible prescription. Because of, among other things, the unbelievable amount of medications that are out there, it's harder and harder for a pharmacist to decipher exactly what a doctor means. When there were, you know, 12 drugs it was easy. Now that there are thousands of drugs that often have similar-sounding names, you can't have any room for error there. I mean, I can't imagine writing a prescription anymore. I mean, it seems so fundamentally wrong at this point.

THE LARGE NUMBER OF AVAILABLE MEDICATIONS ALSO INCREASES THE LIKELIHOOD OF DANGEROUS DRUG INTERACTIONS AND ALLERGIC REACTIONS. BERKOWITZ SAYS HIS SYSTEM CATCHES THEM AS WELL.

Berkowitz 2: For example, today a patient was in complaining of an ankle sprain. I started to prescribe him some Naproxen, which is a standard anti-inflammatory, and the system reminded me that he had had an allergic reaction to Motrin, a similar drug, in the past, and had a bad reaction to that, and that I shouldn't, you know, shouldn't be prescribing that medication. You know, those are things that, you know, of course, we try to avoid, and it's not something that commonly happens, but when it happens, you know, that's very important. It's a simple thing. Right? Just 'Hey, the guy has an allergy to this class of medication. You have to be careful.' [might need to end it here — final line is not too clear} You know, those are things that humans are good at, we're very good at, but we're not perfect at that. The computer can be perfect at that.

BERKOWITZ CREDITS THE HOSPITAL'S PAPERLESS MEDICAL SYSTEM — AND ITS INHERENT LEGIBILITY -- WITH HELPING SAVE THE LIFE OF ONE OF HIS PATIENTS. HE TELLS THE STORY OF AN ELDERLY GENTLEMAN WHO GOT SICK DURING A FLORIDA VACATION FOLLOWING MAJOR SURGERY. THE PATIENT WAITED UNTIL HE GOT HOME TO SEEK MEDICAL HELP. BY THE TIME RICHARD PECK CAME INTO BERKOWITZ'S OFFICE HE HAD AN IRREGULAR HEART BEAT AND AN EXTREMELY HIGH FEVER.

Berkowitz 3: I decided he had to go to the emergency room to get immediate care. We had an ambulance come. At that point, I actually printed out my note, which on legibility alone is a huge, you know, lifesaver, quite honestly, because instead of trying to explain everything to the paramedics and give them some handwritten copies, I printed out my note with all this information, gave it to them, you know, reviewed briefly what was going on, and they could review all of this as they were taking him to hospital and stabilizing him. And then the same thing would happen within the hospital in the emergency room, they're able to access all my old notes, any labs that were done on him, his surgical notes. Everything was right on the system, immediately, the second he went in the door, rather than having to try and wait for an old medical record to be found and shipped to the ER, which, quite honestly, often takes so much time the patient is already out of the ER by the time it gets there. And, quite honestly, in the old days, you know, unless things were dictated, then it would be fairly illegible.

RICHARD PECK AGREES WITH DR. BERKOWITZ'S ASSESSEMENT — HE HAS HIGH PRAISE FOR THE QUALITY OF CARE HE RECEIVED.

Peck 1: Having the information about my medical records on the computer at [eliminate Northwestern] the Hospital might have saved my life, ...by the time I got to the Emergency Room, they had already contacted my urologist, who had done the surgery on me, and they had a course of action planned out. I was admitted to the Intensive Care at the emergency room, and they immediately hooked me up to IV and started to giving me heavy doses of antibiotics. And I guess I was dehydrated. And, you know, they just did everything right.

PECK HAD A SYSTEMIC INFECTION AND SPENT A COUPLE OF DAYS IN INTENSIVE CARE. AFTER THAT CRISIS PASSED, HE HAD ANOTHER APPOINTMENT WITH DR. BERKOWITZ AND DISCOVERED HIS BLOOD PRESSURE HAD SHOT UP. BERKOWITZ WENT ON-LINE, REVIEWED THE MEDICATIONS PRESCRIBED IN THE HOSPITAL AND TWEAKED HIS PATIENTS REGIMEN FOR HYPERTENSION.

BERKOWITZ SAYS THE VAST MAJORITY OF HIS COLLEAGUES CAN'T IMAGINE GOING BACK TO A PAPER-BASED SYSTEM — THAT'S A GOOD THING, ESPECIALLY FOR PATIENTS LIKE PECK WHO HAVE A COMPLICATED MEDICAL HISTORY.

Peck 2: Dr. Berkowitz has all of my prescriptions, and there's one of them I can't pronounce, on the computer. So over the last three or four months, I've wound up seeing a number of different doctors in different departments [cut at Northwestern Memorial Hospital], and I must say it's sort of a good thing. If I've got an appointment, I go in for the first time, I say, 'I'm Mr. Peck. I have an appointment with Dr. So-and-So.' They tap my name into the computer, and they say, 'Are you still at [cut 195] North Harbor Drive?' And I say, 'Yes.' And they've got all the information, they know what medication I'm on, so that they're not going to prescribe something that might have a bad affect on some other prescription that I might be taking.

THERE'S PLENTY OF ROOM FOR GROWTH IN THE USE OF THIS NEW TECHNOLOGY. A RECENT STUDY SHOWS NATIONWIDE THAT JUST 9 PERCENT OF DOCTORS USE E-PRESCRIBING — 17 PERCENT OF PHYSICIANS USE SOME FORM OF AN ELECTRONIC HEALTH RECORD.

FOR THE COMMISSION ON SYSTEMIC INTEROPERABILTY THIS IS KRIS REBILLOT REPORTING.

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