Residents can delegate someone such as a son or daughter to have access to their medical records in case of an emergency.
From 21st Century Health Account I would estimate only about 10% to 20% of doctors’ offices now use electronic medical records to help maximize patient care,” says Matt Narrett, M.D., Erickson Health chief medical officer. That is the premise behind the Resident Health Portal (RHP). It provides Erickson residents with access to their online records.
Using the Portal “Residents can use the program on either a Macintosh or a Windows computer, and access it through any Internet browser, like Internet Explorer or Netscape,” Harris says. Residents don’t have to have their own computer. They can use the community’s on-site computer lab or go to a library for access. If an outside specialist prescribes a new medication to registered RHP residents, they have several ways to apprise the Medical Center of needed updates. “They can call the Medical Center; send updates by e-mail; or print out their data sheet, write in their changes, and bring the revised data sheet to the Medical Center,” says Joseph Schneebaum, senior software engineer at Erickson Communities and one of RHP’s designers. Such updates have at least two
potential benefits. It can help prevent the dangers of polypharmacy—taking too many medications that may interact negatively. It could also save money. There is a migraine drug that also fights stroke. A printout like the RHP’s might allow the doctor treating your migraines or high blood pressure to suggest that 2-for-1 medicine instead of two different drugs—thus saving you money. On-site training for the program’s use is provided. “It took me about 15 minutes to get the hang of the RHP,” says Bill Engel, resident of Charlestown, an Erickson community in Maryland. “I printed out reports and sent one to each of my kids in case of an emergency,” Engel says. Allowing Access, Providing Security “We have a ‘delegate’ feature that allows you to give someone else access to your records. For example, you tell the RHP you are giving your daughter or your specialist access and then provide a PIN number. It is just like getting into your ATM account,” Harris says. “You need three IDs before you, or someone you delegate, can access your medical records using the RHP. You get your own access code, a PIN number (which the resident generates and can vary for different delegates), and your chart ID number. The password is case sensitive. You (or your delegate) have to get it right; after five failed attempts the system locks you out,” Harris says. “Older people are being encouraged to become more involved in
From Electronic Medical Records patients at a much lower cost,” says David Ellis. As director of planning at the Detroit Medical Center, Ellis cofounded the Michigan Electronic Medical Record Initiative, which died due to lack of funding. The challenge is helping the average practice afford truly integrated systems, but experts are optimistic. “There are a lot of options for funding . . . and not just through the federal government. One study noted over 68% of medication errors resulted in serious consequences, including hospitalization, disability, even death. The millions of dollars health care might save just from using EMRs to avoid prescription drug errors could probably repay the costs,” Russell says.
Want more health information? Visit our Health Secrets archives at www.EricksonTribune.com.
Erickson Health helps Erickson residents maintain their independence, with as few as 1.6% moving to assisted living per year.1 Erickson Health achieves this through an extensive array of people, resources, and programs specializing in health care for older adults. Based on 2006 data from an established Erickson community
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5510998-EH 08/07
Defining the Resident Health Portal “The RHP extends the usefulness of Centricity by allowing residents the ability to manage their health information. Among the parts of their Centricity records, RHP shows residents: their chronic medical conditions, medications, allergies, current insurance information, and emergency contact information,” says Diatta Harris, director of information technology at Erickson Communities. “It isn’t unusual for the patient to be the only one who knows all the personal medical information that is accurate,” Narrett says. “Think of allergies: People might not remember to tell every doctor they see they are allergic to peanut butter.”
our own medical life. The RHP very quickly appeared to be a tool toward that, and I haven’t been disappointed,” says Beth Currie, Charlestown resident.
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Computers and Your Health: What You Need to Know
The Tide Has Turned in Favor of Electronic Medical Records A few years ago, issues about privacy and security made most people wary of having their medical history available online, but opinions seem to have changed. Maybe it was the Katrina disaster that awakened people to the need for electronic medical records (EMRs). Throughout the devastated Gulf, people’s health records were totally destroyed in doctors’ offices and hospitals. A study commissioned by Erickson and released as part of a bipartisan Congressional forum indicates Americans favor EMRs by an overwhelming margin—72%—even when presented with security issues. Approximately three-quarters of the population would like a portable device to carry their EMRs from doctor to doctor, while on vacation,
or for other conveniences. That includes people over age 65: 75% in this age group alone would like such a device.
EMRs not as close as you think If you believe you are likely to have this access any time soon, think again. The Erickson study shows that 66% of Americans believe health care providers already Erickson communities use an electronic medical records system called Centricity, have fully implemented EMRs. That isn’t true. The giving both patients and health care providers thorough and instant health information. sad fact is, at most, 20% of states. All these communities are tied health care providers have this lifetogether with the Centricity electronsaving technology available. ic medical records system, which has There are now 20,000 residents been online since 2003. Centricity in 20 Erickson communities in 11 contains medical histories, allergies, medications, and family contacts. Matt Narrett, M.D., Erickson Health chief medical officer, has regularly 2015, but it would only be available seen Centricity help Erickson Health to health professionals. Since 2003, an electronic system called Centricity physicians provide better care for their patients—even when that has allowed Erickson Health physipatient is far from home. cians instant access to the medical records of residents who are regisDoctors Seeking EMRs Too tered. For years, even doctors weren’t What about allowing consumers access to their records—and making that enthusiastic about EMRs. At first, they had the same reasons as those records portable? “Currently consumers. “The American Academy you can go onto the Internet and of Family Physicians (AAFP) did check the money in your bank two surveys on EMRs, one in 2003, account. The time has come for you one in 2005,” says Steven Waldren, to also be able to check your health M.D., director of the Center for care information, such as the mediHealth Information Technology cines your doctor has you taking. Continued on the back Continued inside
The 21st Century Health Account Pretend you are an adult over age 70 going to a new cardiologist. Which of the following scenarios would you like to have at the cardiologist’s office? 1. Filling out endless paperwork regarding your current medications, allergies, and so on (hoping you remember it all). 2. Handing the doctor and the staff an easy way to access your information, which is back in your primary care doctor’s computer system. The odds are you would choose option number two. President Bush has called for an electronic medical records system to be established by
From Electronic Medical Records (CHIT) and a spokesperson for AAFP. “In 2003, we found issues like privacy and security for patients were high on our members’ minds. By 2005, those issues had pretty much been addressed. Instead, money is now the issue. How is the average doctor supposed to fund the costs?” he says. “A basic program, keeping track of simple health information, can easily cost your doctor up to $30,000. If your physician wants an EMR that lets him share information with hospitals and insurance providers, to provide you with topnotch care, his costs can probably balloon to $100,000,” says William Russell, M.D., vice president and regional medical director for Erickson Health. Computerization’s Instant Access Both consumers and physicians reap three benefits from truly computerized medical records: improvements in efficiency, quality, and safety. “Having used both paper and electronic records, I can tell you it’s much easier to access a patient’s information in an electronic system, especially an older person’s data that may be spread among various specialists, hospitals, and diagnostic centers,” says Karen Bell, M.D., director, Office of Health Information Adoption in Washington, D.C.
Spur EMR implementation
T
he message is clear—EMRs can save lives. But this lifesaving technology may not be available across the board any time soon, due to funding and other obstacles. You can help spur action by asking your doctors if they have an electronic medical records system. Even more important, ask what they are doing to make sure their systems interconnect. A major medical center may have an EMR—but it usually has no connection to your doctors’ private practices.
“Think about the times you called your doctor’s office seeking test results. How often were you put on hold while the staff sought your chart?” Waldren asks. With an EMR, the staff has instant access to that information.
Health physician at Eagle’s Trace, an Erickson community in Texas. “It saves the consultant from doing a complete history,” she adds. The time the doctor would have spent on the history is time he can spend on your exam.
Improving Quality of Care “Unlike paper, an electronic system helps enhance my diagnostic skills. Let’s say a patient comes in with chest pains. I might initially suspect heart disease and consider admitting her to the hospital,” Russell says. “Thanks to Centricity, I see her history easily—including lab tests, family history, and last EKG— and realize it’s very unlikely she is having heart trouble. With a few extra questions, and some prompts from the EMR—I realize she’s having a panic attack. I treat her accordingly, and save her the expenses and fears of going to the ER.”
Safety Enhanced, Too Avoiding dangerous drug interactions are a major advantage of EMRs. “Most older people are on multiple medications,” Waldren says. “With an EMR, I can see if I can provide better treatment by switching someone to another drug. I might also save them money and from falling into that ‘donut hole’ in the Part D drug plan.” Think of the dangers when your doctor isn’t available. “It is hard for your physician to remember everything about your history if you call late at night. What if someone else is on call? Thanks to Centricity, if I am the on-call doctor I have instant access to your history, so I’m less likely prescribe a dangerous course of action than someone without that kind of access,” Russell says.
EMR supporters agree you should be able to check your healthcare information as easily as your bank account. “The Vioxx recall is an excellent example of computerization’s benefits. Within 15 minutes of the government’s notice, Centricity allowed Erickson Health physicians to identify all 331 residents across the country taking this drug. Within 12 hours, all were alerted to discontinue Vioxx and see their doctor,” Russell says. “And because each Erickson Health physician only sees 400 patients (versus at least 2,000 for most physicians) we had time to schedule almost immediate consults for those people,” he adds. Taking Your Records Outside “It’s great having Centricity. When I refer a patient to a new specialist for consultation, I print out their history, lab tests, EKGs, etc., to take to that new doctor. In Houston, EMRs are not that prevalent, so other doctors are amazed at what the Erickson Health system can do,” says Raina Patel, M.D., Erickson
Maintaining Privacy “If anyone thinks paper records are secure and private, they have never spent much time in a doctor’s office. Records are left out all the time for coding, filing, and faxing,” Bell says. “With paper systems, all you can do is lock the chart room. But an electronic medical record has passwords and security precautions, and I can tell who has accessed it,” Waldren says. That doesn’t mean patients shouldn’t be concerned. “Ask your doctor: ‘What are you doing to protect my records?’ He should be able to tell you,” he adds. Getting Funding Ultimately most people, especially physicians, agree on the value of EMRs. “I am at a loss as to why there is so little funding for EMRs. Study after study has shown a network of interoperable EMRs would result in much better care for Continued on the back
Should the Internet Be Your Health Info Expert? The Internet makes it easy to flood consumers with health information—not all of it legitimate. While latest research indicates adults age 65-plus are only about 1/3 of the Internet market, they are a market that can be particularly vulnerable to misleading medical information.
The Internet’s Plus Side There is lots of reliable health information on the Internet, thanks to major medical centers, teaching universities, and well-known nonprofits like the Arthritis Foundation. That means with Internet hook-ups, older adults now have almost instant (and free) access to a wide range of common health topics. With the Internet, you can also find information on lesser-known technologies, medications, diseases, and other health data you otherwise wouldn’t have access to—at least not without a trip to a medical library. Such a trip not only requires muchneeded patience for some heavy digging, it often isn’t a viable option for older adults; one out of five no longer drives. Who’s Watching the Web? For now, there is no regulation of websites. The same TV ads that tout they can cure your arthritis pain instantly with one pill or some cream are all over the Internet. But unlike TV, it isn’t always easy to spot an Internet ad. “Some are easy to see. They are the banners across the top of your screen or the little boxes off to the side. Many are marked ‘Sponsored Links,’ which at least alerts you there is generally a commercial interest behind them,” says William Russell, M.D., vice president and regional medical director for Erickson Health. A recent search for arthritis info showed sponsored links offering “rapid relief” through a triple-therapy remedy and “grandma’s cure” for your pain.
The Internet can provide lots of health care information and resources. Be careful, not all of it is reliable.
But far too often, your search leads to a web address with no indication of its content. The website (let’s pretend it’s called “painfighter. com”) may tell you who the people touting the product or service are— but not always. Even if the site seems to be sponsored by legitimate health experts, how do you know their agenda? Whereas 20 years ago it was seen as unprofessional for doctors to advertise, they (and other health professionals) are now perfectly free to post a website. Some use it to sell their own remedies, books, CDs, and other moneymakers. Hidden drug dangers for older adults “Even if you are utilizing reliable websites for help with a medical condition, not all of them address the specific needs of a senior audience. Are you taking three or four medications? Americans over age 65 are only 13% of the population, but account for over a third of all prescriptions filled,” Russell says. It is no longer unusual for older adults, trying to save on prescription costs and avoid falling into the
“donut hole” in Medicare Part D, to order lower-priced medications outside the U.S. Among the dangers of such purchases, says the Food and Drug Administration, are: buying expired drugs, products with dangerous ingredients, and medications that are either dangerously strong or weak. One example: APO-Warfarin, an unapproved, foreign version of the blood thinner warfarin. Even reputable websites don’t always indicate dangers of certain medicines for older adults. For example, to help you sleep you might look up one commonly used, approved brand-name nighttime pain reliever. “There is one blacklisted for use in people over age 65. For various reasons the component that helps you sleep, diphenhydramine, causes delirium, agitation, and other problems in older adults,” Russell says. Older adults are among the leading sufferers of chronic pain problems—up to 80% of people over age 65 are affected. But experts agree: anything that promises a one-sizefits-all remedy is unlikely to relieve anything except your wallet.
Anything that promises a one-size-fits-all remedy is unlikely to relieve anything except your wallet. Drug purchases now account for most of the $93 million that consumers spend each year for health care over the Internet, but growing numbers of people are buying medical devices online. While magnets or copper bracelets probably won’t hurt you, other non-approved, nontested devices can. “People are buying hearing aids online. That is not wise since these need to be fitted and tested properly for each individual,” Russell says. Ultimately, experts agree, you should ask either your primary care doctor or a specialist about any health information you see online. “Download the item and bring it in. A good doctor will always find the time to discuss new possibilities with you,” Russell says.