Electronic Health Records Today

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Another way to get physicians practices involved is to extend an application they are currently using online. Quest division MedPlus offers a system called Care360, which physicians use for e-prescribing and placing lab orders. It is centrally hosted and benefits from the vast stores of data that Quest has on hand to provide benchmarks for the lab test results as decision guidance
for the physicians. The new suite is called Care360 EHR. The screens in the application are designed to reflect the flow of a patient-doctor encounter, or "SOAP, the subjective, objective, assessment, plan" that Nayak describes as central to the doctor's workflow.

Finally, at White Memorial Medical Center, they have taken the first steps toward digitizing patient charts by using the XEROX DocuShare system, which White Memorial deployed in its emergency room. By scanning and storing paperwork directly into DocuShare, the hospital saved as much as $200,000 on storage fees and administrative costs per year, reduced insurance claims denials, and improved billing processes. Because emergency is a critical area, the documents are scanned overnight and are available for the business office in the morning. Bryant states the primary advantage is that the invoices can be generated using a paperless system.

The XEROX DocuShare system at White Memorial Medical Center was implemented by WaterWare of San Jose, Calif. WaterWare works as a system integrator for DocuShare and has designed a document workflow platform called the Nile system, which is integrated with DocuShare as the main user interface. In addition, WaterWare has added another system to the White Memorial arsenal called Nile Pharmacy, a pharmacy order management system to complete and prioritize physicians' pharmacy orders.

New patients are assigned a bar code for all of their information, which gets scanned directly into the appropriate medical file stored in DocuShare. White Memorial Medical Center has done production-level scanning of large volumes of past patient files as well.

What the Future Holds
It is clear that a more patient-centric electronic health record should result from widespread use of EHR, the federal incentives, and health information technology standards initiatives in motion today. The new standards are helping existing players to strengthen their offerings, to make them more oriented toward the patient record, to bring about greater data exchange, and to encourage new entrants who think they have built a better mousetrap that physicians will adopt.

Though the federal government is providing a strong set of incentives, it is the major economic forces, the systems vendors, national providers, and the large hospitals that will push adoption further than it has gone before. Publically funded, or partly so, efforts such as HIEs may fall prey to the gold-rush mentality of the American Recovery and Reinvestment Act and overspend on systems that are too expensive to maintain in the long run. Even if certain HIEs fail in the future, interoperability and data standards may make these events matter less. If the ONC succeeds, the data will be more portable and readable by every system certified to be a part of medical technology today. Perhaps then, health information will truly exist in a secure cloud.

Still perhaps, as individuals and not technology professionals, we all wonder, as Marydale DeBor, VP of external affairs at New Milford Hospital in Connecticut does, "When will we no longer have to fill out that darn little clipboard every time we go to the doctor's office?"

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