KU Hospital switches to electronic records

By Courtney Condron

Thursday, November 13, 2008

When a patient called Steve Owens, University of Kansas Hospital cardiologist, a few years ago with a question, it sometimes took Owens two days to request and obtain the patient’s chart.

Now, all Owens has to do is log on to the hospital’s electronic medical record (EMR) system, and he can pull up past treatments, allergies and illnesses. He can access medical records not just from his office, but from offices throughout the hospital.

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Photo by Ryan Waggoner

Anna Gerken, a nurse at the Mid America Cardiology Center at the University of Kansas Hospital, demonstrates the hospital's electronic records system. In October 2007, the hospital bean the process of converting all of its paper files into digital files, making it one of the first hospitals in the Kansas City area to switch to electronic records.

“When I’m on call, I can access the record and review the patient’s history, even if I’m not personally familiar with the patient,” Owens said. “It allows me to be a lot more accurate in answering the patient’s questions or concerns.”

The KU Hospital is in the second stage of a five-year, $51 million transition to all electronic records.

This system allows doctors to automatically pull up any information about past visits the patient had at different departments and offices within the hospital. For some patients, there is some anxiety about whether their records are safe and private, but for doctors this system has increased efficiency.

“Trying to operate a hospital on paper is very difficult, if not impossible these days,” Doug Erich, who directed the EMR switch, said. “With a paper chart, if a patient went to another department in the Hospital, we’d do the best we could to get that paper chart along with them, but at times it would get lost or delayed.”

Erich said that having the information in the electronic system allowed information to go where it needed to go, so that care providers at the patient’s next stop would have access to that information.

For nurses, using computers reduces the chance for errors. They are no longer scribbling down a patient’s information on a chart, but rather inputting it into the computer.

Even cardiac devices that monitor heart rate and breathing are directly connected to the electronic system, so a nurse no longer has to log that information on a spreadsheet. Information that has been gathered on paper is now being scanned into the computers, so that electronic records will include as much of a patient’s history as possible.

Erich said that each nurse had to go through 16 hours of training to learn how to correctly use the software. The KU Hospital also bought several hundred new computers for physicians and pharmacists to use, including carts with laptops so that nurses and other care providers can roll computers from unit to unit.

With records stored online and the accessibility of this information, there is some concern of privacy for patients. For example, if a patient goes to her gynecologist at the KU Hospital for an appointment, and then returns to the emergency room three weeks later for a broken foot, the ER doctor will be able to see any information that the gynecologist put into her file.

But having information from a previous appointment will often help doctors. They will know what medication a patient is currently on and if they are allergic to anything and how badly they are allergic to it.

The security system at the KU Hospital does make sure that not just any doctor can look up a patient’s information. A portion of the Health Insurance Portability and Accountability Act (HIPAA) is based on keeping a patient’s information secure and confidential.

“Privacy of the patients’ information is a major portion of treatment as far as I’m concerned,” Irwin Weinberg, KU Hospital Information Security Officer, said. “When you come into the hospital, we want to be able to tell you that you are going to get the best treatment, and that information is going to be protected to the most optimum degree possible.”

Weinberg said this was done with “audit trails.” Each physician has an “audit trail” that shows where he or she has gone on the computer and what they have looked at. These trails are permanent and can always be accessed by security.

Each person has his or her own log in and password. If a physician is looking at a patient’s records that he or she shouldn’t be, then this will signal “red flags” to security.

“The vendor, Epic, pretty much has to build their system around the requirements that HIPAA sets for the record, so there’s lots of security set up,” Kay Grasso, director of clinical informatics, said. “We make sure that people are trained on the system, that they fill out a confidentiality form, that our security within the system is set up appropriately and we follow those HIPAA guidelines very stringently.”

Weinberg and other KU Hospital security officers have met with doctors and nurses in various departments to make sure they are aware of the security features. They have also run campaigns on how to use passwords properly and send secure e-mails.

Owens said that just knowing the security had “audit trails” inhibited people from accessing a record.

“Everyone in the institution is well-versed on the methods to protect privacy,” Owens said.

EMRs also help secure records, because they can’t be left lying around like paper records. Weinberg said he had once seen a nurse leave a cart of medical records out in the hall while she went to the bathroom. This wouldn’t happen with EMRs. Even if a computer wasn’t being watched, only a nurse or doctor would be able to log in to the system to view records.

As the KU Hospital finishes the second stage of the transition to electronic records, there is still much to come as more of the EMR system is implemented. At this point, the hospital is still working on putting many of the ambulatory clinics on the same electronic system. Eventually, a patient portal will be built to allow patients to schedule appointments, request prescriptions and look at lab results online. Ultimately patients will have the capability to go online and view their own records.

Dennis Minich, senior media relations coordinator for the KU Hospital, said that the system could go even further in the future. Eventually, patients may have all of their medical information programmed on their insurance cards, and all they have to do is hand them to the doctor, who swipes them and they have all of a patient’s information readily available.

Owens said that electronic records were a major step forward in health care because there was an incredible amount of time spent getting information from other departments or other institutions when caring for a patient.

“Electronic records will facilitate the timely exchange of patient information,” Owens said. “It will allow us to make better-informed, more timely decisions on behalf of patients.”

— - Edited by Jennifer Torline

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