Doctors throughout Duke University Health System may soon throw out prescription pads and hefty manila folders in favor of digitally accessed medical records.
DUHS last month linked the medical files at Duke Health Raleigh and Durham Regional Hospital, in the first step toward potentially making all health system patients' files electronically managed.
In late July, DUHS launched the pilot stage of its ambulatory electronic medical record system, which aims to reduce errors caused by paperwork and more fully integrate medical records among DUHS's 80 to 100 outpatient clinics, scattered throughout North Carolina.
"We hope to create a continuum among doctors, nurses and all those involved in the full process of treating patients," said Roman Perun, manager of internal consulting for Duke Health Technology Solutions. "A full-scale system of this type across Duke's health system is today unprecedented."
The electronic medical technology will encompass an integrated system for recording and viewing patient progress notes, order entries, records of discharge, nurse's notes and some procedures notes-all of which are currently in paper form.
The technology used by DUHS is provided by McKesson Corp., and Duke has a four-year contract with the company to tailor the computer programs to the heath system's needs.
The contract will likely be extended as digital records are implemented more widely, said Dr. Mike Russell, associate chief information officer for DUHS.
"E-prescribing" systems-which automatically alert doctors to adverse drug reactions and allergies-will also be launched in all of Duke's outpatient settings during the next 16 months, replacing prescription pads.
"This will help us understand fully what patients are taking with more knowledge and precautions," said Russell, who is also a physician in Duke's divisions of pulmonary medicine and allergy and critical care.
"It bridges the disconnect among patients and doctors regarding what patients are buying... this includes those who go 'doctor-shopping,'" he added.
Information officers involved in the project said another major goal is to ease patients' transitions from hospital stays to clinic checkups.
"In the inpatient setting, a nurse comes in, gives you medicine and watches you swallow it," Russell said. "The outpatient world is less structured-you can't expect the patient to know what's going on or prevent mistakes... some patients come in with two bags of medications."
During the past decade, critics of the national healthcare system have lobbied for increased use of electronic medical records-a cheaper, more easily transferrable alternative to paper records systems, said Christopher Conover, assistant research professor at Duke's Center for Health Policy.
National studies of health system reforms have found that paper data systems, adverse drug reactions and complications for patients with complex treatment regimens have claimed billions of dollars in recent years, Conover said.
He pointed to Kaiser Permanente-a national not-for-profit healthcare provider- as proof that electronic medical record systems can be successful and economic.
Despite evidence that electronic record systems lower healthcare costs and boost efficiency, transitioning from paper systems can be costly and risky, Conover said.
"Duke has made great strides in the past, but clinics across the nation are faced with a dilemma in deciding to take up these systems," he said. "You don't want to make a twenty or thirty thousand dollar investment on the wrong stuff."
A report released this summer from the Institute of Medicine found an average of 1.5 million preventable medication errors per year and recommended that all prescribers and pharmacies take up e-prescribing by 2010.
In addition, Congress has recently passed bills that promote the adoption and sharing of digital records.
"I think it's great that Duke is building upon its strengths, and hopefully the network will expand outside of its current boundaries someday," Conover said. "Only time will tell."
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