Anyone who’s had to deal with a recurring illness or had a loved one in the hospital knows the frustration of finding out that the X-rays or other needed medical records never seem to be available at the right time and the right place.

Hospitals and physician groups have been working for years to develop effective system to make medical records available electronically, and it appears that they’re now on the road to a truly paperless health-care system.

Iowa Health-Des Moines officials estimate their hospitals’ electronic medical records, or EMR, systems are about 75 percent complete, and they are now turning their efforts toward bringing the outpatient clinics online with the technology.

Mercy Medical Center, which abandoned an early effort at implementing an EMR system five years ago, is now in the first phase of a renewed effort to fully automate its records system by 2009.

The move toward electronic medical records is gaining momentum nationally as a tool for increasing the efficiency of the health-care system, reducing medical errors and reducing costs. In a recent speech to medical professionals in Baltimore, President George W. Bush outlined a goal for all hospitals in the United States to adopt electronic medical records technology within the next 10 years, with the promise of federal funding to assist hospitals in implementing it.

“We were pleased to hear that,” said Cristina Thomas, Mercy’s chief information officer. “We knew that the industry was going in this direction, but we were glad to see the government acknowledge its importance.”

Dr. Tom Evans, a past president of the Iowa Medical Society and Iowa Health System’s chief medical officer, said doctors are generally frustrated at how long it’s taken to move forward with electronic medical records.

“We think this should be easier to deploy than it is,” said Evans, whose physican practice tried to implement an EMR system in the mid-1990s but abandoned the effort because it created more work than it was worth. “We’re all used to going to the computer store and just getting an application off the shelf. That’s not the case with this, and that’s been a challenge.”

At Iowa Health-Des Moines’ three hospitals, functions such as patient registration and many aspects of the patient-care information system are updated by staff directly into patients’ electronic charts and are immediately accessible to the doctors and nurses.

Both Iowa Methodist Medical Center and Iowa Lutheran Hospital this month began using the Picture Archive Capture System, which allows physicians to instantly pull up patients’ diagnostic images together with the patient’s chart, anywhere there’s access to a monitor.

Next year, Iowa Health plans to introduce bar-coding of medicines at its Des Moines hospitals, which will tie in with the armbands patients wear on their wrists to ensure they’re receiving the correct medication and at the right time and dosage.

One of the next phases will allow doctors and nurses to enter orders for procedures or medications directly into the system at the patient’s bedside.

“We would do that more on a pilot basis to begin with, to make sure the bugs are worked out before we move that to the broader medical staff,” said David Stark, chief operating officer of Iowa Health-Des Moines.

Patients would be hard-pressed not to notice the technology, which is apparent throughout the hospitals, Stark said. Each year, Iowa Health-Des Moines spends about 3 percent of its capital budget on technology.

“We certainly try as much as possible to make it transparent to the patients, because they come not for the technology but for the patient care,” he said. “They don’t know about all the technology behind it, but they don’t have to. But we know it’s a satisfier, because it’s a dissatisfier if it’s not there.”

Mercy, which in 1999 wrote off between $8 million and $10 million in costs after it jettisoned an unsatisfactory EMR system that was 60 percent completed, has built on that failure as a learning experience, Thomas said.

“From what I know the product itself probably wasn’t mature enough,” she said. “And we probably overengineered it. We built it to where it became a little too cumbersome for users, and there wasn’t a buy-in from the users, because it was chosen by the information technology department and senior management.”

Mercy, which expects to invest about $20 million over the next five years on EMR technology, is taking a three-phase approach to implementing it. The first phase includes scanning existing paper records into the electronic format after patients are discharged. A second phase, planned to be implemented two years from now, will allow hospital personnel to input patient information directly into hand-held devices on a real-time basis.

“This is really where we will have in place a true electronic medical records system,” said Thomas, who said physician order entry is scheduled as part of the third phase that will kick off by 2007.

At Mercy, a key aspect of going electronic will occur in the first phase with the creation of a unique “Enterprise Master Patient Index” for each patient that will identify that person throughout Mercy’s system, regardless of whether they’re seen on an inpatient or outpatient basis, Thomas said. That’s expected to reduce the number of duplicate patient records, which occur primarily when people use different names when they register at the hospital or clinics. Mercy estimates it has a duplicate record rate of 4 to 6 percent, which is about on a par with the national average.

Reducing the potential for medical errors because of illegible handwriting by staff or physicians is another factor driving the move toward electronic records.

An example of how that can work is in practice at Iowa Health’s outpatient clinics, where doctors have been writing electronic prescriptions since 1998, said Jim Mormann, Iowa Health’s chief information officer. The system has built-in safeguards that allow the doctor to check for possible drug interactions before sending the prescription to the pharmacy the patient chooses for pickup.

Iowa Health plans to begin introducing full electronic medical records at its clinics, beginning with its new Johnston clinic as well as its clinic in Ankeny, Mormann said.

“The reason that’s so important is you’re going to spend the majority of your time with family practice or specialists,” he said. “So we need to be spending a lot of our time in the outpatient space. Our goal is to get this up and running in all of our outpatient clinics.”

IOWA HEART’S WEST DES MOINES CLINIC WILL USE EMR

When Iowa Heart Center opens its new West Des Moines clinic next summer, it will be missing just one thing: paper records.

The cardiovascular practice plans to invest in an electronic medical records system that will make patients’ records immediately available to their doctors at any location through a secure remote server.

Building a brand new-facility gives Iowa Heart Center the opportunity to design the system into the structure, said James Palazzo, Iowa Heart Center’s chief executive officer.

“We’re really excited about that,” said Palazzo, who said relatively few cardiovascular practices around the country have made the investment to go paperless. EMR systems of the size needed for clinics generally cost between $1 million and $2 million.

“The quality is that the records are immediately available, rather than having to send across town for them or wait for them,” he said.

A complementary technological tool that will be built into the new clinic is digital imaging, which the practice already uses at each of its clinics. Digital imaging allows physicians to pull up still or video images of the heart and other data, such as electrocardiograph results.