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September 19, 2005

Dr. data | Inland Hospital execs talk about their new electronic medical records system

By Michaela Cavallaro
With just 48 beds, Waterville's Inland Hospital is a small player in Maine's health care industry. But a few months ago it took a large step into the future when it implemented the first phase of an electronic medical records system. The system, whose adoption had been spearheaded by Inland's corporate sibling, Eastern Maine Medical Center in Bangor ˆ— both facilities are part of Eastern Maine Healthcare System ˆ— allows medical personnel to access patient records no matter where in the EMHS system the patient is being treated.

Dr. Michael Palumbo, an emergency room physician who is also Inland's vice president for medical affairs, says Inland executives hoped to reduce medical errors, as well as make long-term efficiency gains, by implementing the system. And Inland Hospital is not alone: According to the eHealth Initiative Foundation, a Washington, D.C.-based nonprofit group, 60% of respondents to a recent survey said dealing with increasing medical costs was a factor in installing electronic medical records systems.

Mainebiz recently asked Palumbo and Pamela Sprague, Inland's nursing administrator, to talk about the changes the new system has brought. An edited transcript of the conversation follows.

Mainebiz: Explain what, exactly, has changed with the new system.

Palumbo: We are a primary care hospital, so frequently patients who receive most of their care here will need to go to [EMMC in] Bangor to receive specialized care. What we've done is take the medical record and begun moving all that information into an electronic storage media, so that it can be accessed anywhere, at any time by anyone that's at a facility affiliated with Eastern Maine Healthcare.

What kind of information is included on the system?

Palumbo: Right now, it's what we call a hybrid chart ˆ— X-rays are on the system, lab work, consultations, radiology reports, vital signs, medications. [But] the progress notes that physicians write when they visit a patient are still paper-based; when a physician orders a drug or a test, they still write the order physically in a chart. The time will come in the near future when that information is entered electronically.

What kind of equipment are people carrying around?

Sprague: They're like laptops, but they're on stands with wheels, so they're portable. We call them walkabouts. We can take them right into the patient's room. We also have stationary computers at the nurses' stations.

What have you found in regard to cost savings from the new system?

Palumbo: The idea was never to put it in place to gain cost savings. The idea was to put it in place for the quality benefits and the safety benefits. The system is capital intensive to put in. I don't think that in the near future if we did a cost analysis we would find that it was cheaper in any respect.

But to the medical system as a whole or to a patient's insurance carrier ˆ— or their own personal medical expenses ˆ— if it indeed saved a redundant test or a hospital admission, [there] certainly [are savings].

How much did it cost to implement this?

Palumbo: The whole thing is millions of dollars ˆ— it's certainly much more than a small hospital such as us would have been able to afford. The reason we can get it is that we tag along with the larger organization as a whole.

How have you dealt with privacy concerns?

Palumbo: There are federal and state regulations that control how the information is shared, and who can have access to it. Our system is compliant with those regulations. It involves security systems that are built into it that limit access to authorized personnel, so that for example someone can't come in from outside and get into the system and pull somebody's medical record.

How has this changed nurses' and doctors' jobs? Is your day different now?

Sprague: It just expedites care. When we change shifts, it's not necessary to spend so much time going over each patient's history, medication. The nurses now can come on duty, go right into the computer, find out everything that's gone on with the patient so they can get right in and see the patients.

Instead of that half hour or 45 minutes where the nurses had to go over each of their patients with the incoming nurse to make sure that everything was covered, now they can go from patient to patient in the computer and get all the data they need. It definitely has made the process much more user friendly.

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