Bush '43 and experts on EHRs

AUGUST 2005

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CIRCULATION OVER 3,000,000

Electronic Medical Records Save Lives

White House Urges Computerization

By Wendy J. Meyeroff THE ERICKSON TRIBUNE

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Meet the Author Silhouettes, How to Cut for Fun & Money by Ann Woodward.

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Erickson Newsbriefs Erickson community coming to Denver, new cooking show at Riderwood, Greenspring wins four ‘Tellys,’ Oak Crest crochets blankets for charities, NorthBay adventure camp ready to open its doors.

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Aford the Turtle The antics of Aford T. Turtle and his friends.

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Good Health Starts Here The latest in knee and hip replacements and what you need to know about choosing and Page 7 using at-home medical tests.

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From the Chef’s Kitchen Chef de Cuisine James Little’s “Seafood Macaroni and Cheese.”

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In his 2005 State of the Union address, President Bush called for doctors and hospitals to make better use of technology to store and share medical records. In a subsequent memo, the White House said, “computerization was necessary because information about a patient is often scattered and unavailable in an emergency.”

Whatever your opinion of the current administration’s policies, the fact is when organizations not only computerize health records but also find a way to share information, people’s lives can be saved.

Mark Leavitt, M.D., Ph.D., chief medical officer of the Healthcare Information and Management

By Wendy J. Meyeroff THE ERICKSON TRIBUNE

Statistics show the face of retirement is changing.

Many age 62 and up see this time as a chance to “not quite retire.” They join communities like those built and managed by Erickson Retirement Communities, and let someone else mow the lawn

In one month alone, more than 80 million U.S. adults purchased and/or consumed organic food or drink.

I trust the government to regulate the chemicals.

I’m concerned about chemicals used to grow food.

57% Eric Lange works full-time designing auto parts and wouldn’t dream of cutting back his hours.

30%

Source: Natural Marketing Institute

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Systems Society, a nonprofit organization dedicated to leading changes in the management of health care information, emphasizes that proper computerization not only helps in an emergency—it helps prevent emergencies.

“Imagine going to a specialist you’ve never seen and he has all your medical records instantaneously.

Think of all the medication errors that could be avoided,” he says.

“Consumers shouldn’t be overly concerned about privacy risks when health care experts share information. Think of it more like getting your money out of an ATM,” Leavitt adds.

“You should be more concerned over the risk of errors if doctors don’t have

and take care of the repairs, while they go off to explore continued or new career options.

According to an AARP study, 54 percent of older Americans say they continue working to keep themselves mentally active, 49 percent want to stay physically active, and 47 percent

State House Photo/ Abby Brack

Massachusetts Gov. Mitt Romney (left) speaks with Sec. of Health and Human Services Ron Preston (center) and Dr. Allan H. Goroll after announcing plans to launch a new initiative to reduce medical errors and save costs by converting paper medical records into electronic form.

Putting Education to the Test

The Pros, Cons, and Maybes of Testing Our Kids

By Keith Gamboa THE ERICKSON TRIBUNE

When the Bush Administration launched its No Child Left Behind (NCLB) educational initiative in 2001, it set in motion a nationwide effort among the states to comply see NOT RETIRED page 2 with the new testing requirements that are such an important component of the law.

As explained in the U.S. Department of Education’s website (www.ed.gov), “Under the law's strong accountability provisions, states must describe how they will close the achievement gap and make sure all students, including those with disabilities, achieve academically.”

The primary means to that end is to gauge progress in “closing the achievement gap” through extensive stuCourtesy of Eric Lange

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Do standardized tests make better students?

dent testing. This is an important issue because the success or failure of children in achieving academic standards not only reflects on students, it impacts the future of schools as well, since lack of progress can

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PAGE 8 From RECORDS page 1 the information they need, than over the risk of information being stolen.”

Stopping Mistakes Before They Start One of the best examples of the possibilities of computerized efficiency is the Centricity electronic medical records system used at communities built and managed by Erickson. The system passed its two-year anniversary this spring, so the professionals in the Erickson HealthSM system have seen first-hand the benefits of effective computerization, something used in less than 5 percent of this country’s health facilities.

But Centricity is not your average doctor’s records system. William Russell, M.D., medical director of Oak Crest, a community in Parkville,

Md., built and managed by Erickson, says Centricity gives him and other Erickson HealthSM physicians instant access to the complete medical histories of more than 15,000 people across eight states.

That’s important when someone is using an outside specialist. “If the specialist has prescribed a drug we don’t know, we use Centricity to check for drug/drug or drug/alcohol interactions. Centricity not only allows doctors to check for interactions between prescriptions drugs, but also between prescribed medications and many foods, herbs, and other remedies,” says Russell. (See the story on natural supplements in the July Tribune online.)

“When patients leave the office, we give them their current list of medications and tell them to com-

pare it to the drugs they have at home,” says Russell.

“If an outside physician prescribes a new medicine not on their list, Centricity helps determine if the drug is appropriate, given that person’s age, medications, and other factors. If not, we talk to the specialist and get another drug prescribed.”

Other Drug-Related Advantages Finding constantly updated information on drug side effects and interactions through computer systems like Centricity helps both doctors and patients.

“If a new product comes out and it’s superior or more cost-effective, we can see for which community members we can make therapeutic substitutions,” says Russell.

Minimizing drug dangers is a major advantage of a system like Centricity.

Photo By Wendy Meyeroff

Erickson Health physician, Eugenio Machado, M.D., (left) demonstrates the Centricity electronic medical records system via his handheld tablet to Mark B. McClellan, M.D., Ph.D., (right) administrator of the Centers for Medicare & Medicaid Services.

SM

From HOME TESTING page 7 for “home” use, Russell doesn’t think prothrombin self-monitoring is a good idea.

“This test is best done by trained personnel because the results require careful analysis, and errors in testing can lead to pretty substantial complications,” he says. Besides, he points out, “prothrombin tests are expensive: about $1,000 and then (like glucose tests) a constant investment in test strips.”

“Home” prothrombin tests have been a lifesaver in doctors’ offices. “Since we’ve started using prothrombin kits in our on-site Medical Center—as opposed to drawing blood and sending it to a lab—we’ve seen a real improvement in the quality of patients’ Coumadin dosing. It’s not out of range as often as it could be when we had to wait for overnight lab results, and complications are considerably less.

Physicians can now make immediate, very fine adjustments to someone’s medication dosage,” says Russell.

Beyond Test Strips There are other home kits using test strips, but Russell finds very few that those 62-plus really need.

“You can do home cholesterol testing, but you might as well have it done during your regular physical.”

Where he sees some interesting developments for average consumers is medical devices they can use themselves. One example he offers is home blood pressure (BP) monitoring which he says generally is a good thing.

As with all home tests, be careful about interpreting results. “Let’s say you have a headache, check your BP, and see your pressure’s up 40 points. Your headache could be the cause of your higher pressure, but that pressure may also have gone up just out of concern over your headache. It’s best to check with your doctor for guidelines,” Russell says.

Patients with heart rhythm disorders might want to discuss home event monitoring with their physicians. “When patients complain of rhythm problems, doctors often recommend wearing a 24-hour heart monitor, but it’s often like taking your car to the mechanic—that ‘weird sound’ disappears as soon as you bring it in. Cardiac events don’t happen every day. It’s a matter of statistics,” says Russell.

But now there are cardiac “home event monitors” that the cardiologist provides which you can wear for weeks. “If you have symptoms, you hit a button on or near the phone and it connects you to a phone

line where a cardiac tech can see an EKG strip, then give that strip to a cardiologist to review,” he says.

The Key to Home Testing Check with your insurer as to which home test and devices they’ll cover. If they give you a choice, talk to a health expert including the pharmacist as to which is a good investment.

Finally, Russell urges everyone to remember, “The main disadvantage to home testing is it doesn’t come with counseling, the way office testing does.” As an example he points to diabetes monitoring. “The beauty of the Erickson HealthSM approach to geriatrics is we address the whole patient, not just a specific disease, like diabetes. If people are going to a special event and want to eat cake, that diabetes monitor and their log book is just part of how we help them find a way to eat cake and still maintain their health.”

He concludes: “Home testing is never a substitute for a physician’s assessment and a treatment plan the doctor can develop for you.

Test results can be misleading or even dangerous if they’re not connected to a doctor’s advice and a total wellness program.”

This spring a study was released showing ten HMOs nationwide were allowing prescriptions to be filled for medications that had been labeled “always avoid” or “rarely appropriate” for up to 15 percent of their subscribers. Erickson HealthSM physicians used Centricity to check these medicines and found such prescriptions had been virtually eliminated among people they were treating.

Last fall, when the drug Vioxx was suddenly recalled, Erickson HealthSM physicians accessed Centricity to find which of the 15,000 residents at Erickson-built and –managed communities were taking it. “We found all 331 residents on this drug and within 24 hours notified them to come in and talk to their doctors about alternatives,” says Russell. “That process could have taken weeks if we were laboring through paper records.”

When Seconds Count Last but not least, a truly advanced computer system helps physicians save lives when seconds count.

“Centricity gives us access to a patient’s records at all times,” says Russell, “something that’s critical in emergency situations. If I get an emergency call in the middle of the night, I can access the patient’s chart and look at his or her most recent data.” That gives the on-call physician a huge advantage in determining if an ambulance or hospital is needed.

Systems like Centricity also help hospitals maximize care. Arlon Quigley lives at Fox Run, an Erickson-built and -managed community in Novi, Mich. When he punctured a lung and suffered other injuries while

From JOINTS page 7 overall—rather than their chronologic age.” Someone may be 65, for example, and not have the upper body strength to handle the walker or cane they’ll need while recovering.

Interestingly, he also checks his patients’ teeth. “I look at whether they’re loose or in poor shape. If so, they need to be fixed; otherwise such problems can lead to bacteria entering their blood.”

McCarthy says, “Medicare often doesn’t reimburse the hospital for newer and more expensive

hiking with his grandkids in Pennsylvania, his physicians back home were able to instantaneously transmit his medical records to the doctors at the Pennsylvania hospital. It not only saved precious time and avoided deadly mistakes, it got Arlon home to Michigan a

AUGUST 2005 lot sooner.

Will nationwide computerization of health records be difficult? Yes. But is it impossible? As Centricity shows at Erickson HealthSM, the answer is No.

Massachusetts Leads the Way This past May, Massachusetts became the first state to officially commit to a statewide electronic medical records system, launching its eHealth Collaborative in three pilot areas.

Governor Mitt Romney explains, “It will allow us to do a better job in treating patients and preserve our resources so that we’re able to help those who need our help the most.”

One of the main barriers so far to such systems is that hospitals and doctors have no real incentive to participate. It costs them money to upgrade systems and they don’t reap the payback; the insurance companies do.

Massachusetts is getting the insurance industry involved from the outset. BlueCross BlueShield of Massachusetts has committed $50 million to the initial project.

To carry the Erickson and Massachusetts programs for electronic medical records systems to a national level, Mark Leavitt, M.D., Ph.D, chief medical officer of the Healthcare Information and Management Systems Society, says four things will be needed. He laid them out in an exclusive to The Erickson Tribune: 1. Money - “I believe there’s more than enough with what we’ll save in health care administration, costly errors, and so on, to pay for the system we need,” says Leavitt.

2. Standards - One of the greatest challenges to a national network is lack of standardization. “We have conflict in systems, like the old VHS versus Beta videotapes,” says Leavitt. He chairs a voluntary organization to create standards.

3. Education - “Doctors and hospitals need education on how standardization benefits them” he says.

4. Consumer involvement - “Getting doctors’ support is critical and you can steer yours toward better utilization of electronics. You should ask, ‘Don’t you have a way to access that information electronically yet?’ or, ‘My neighbor’s doctor lets her email questions in the middle of the night. Why don’t you?’

“Then imply that maybe you’ll switch to your neighbor’s doctor,” he laughs. “That’s when we’ll get the doctors on board.”

technology, such as metalmetal or ceramic-ceramic bearings.” So while those 65-plus can potentially benefit from these advances, they may not be encouraged to use them. The only real solutions: talk carefully to both your surgeon and the hospital, and start lobbying Congress.

Optimizing Surgery Results Both McCarthy and Bennett agree with William Russell, M.D., medical director of Oak Crest, a community in Parkville, Md., built and managed by Erickson, that a total team approach is critical to optimizing the efficacy of replacement joints. “Every patient should include their primary doctor, especially if he/she is a geriatrician who is trained to deal with the whole patient,” says Russell. “I can’t tell you how many times I’ve seen someone get a joint replacement, then doesn’t have the energy to participate in rehab adequately. They end up worse than when they started.”

McCarthy adds, “Direct communication is critical: between the surgeon and the patient’s primary doctor; between the specialists, the primary, and the surgeon; and between surgeon and the patient.”

He adds that for such communication, “a system like

Centricity (see page 1) is great.”

Speaking of rehab, it’s critical the patient commit to it because—as Russell notes—“You only have a relatively small window of post-op opportunity to optimize results.” McCarthy encourages patients to exercise before surgery, so as to strengthen muscles. Russell notes that residents at communities built and managed

by Erickson often have a team approach available, thanks to on-site rehab facilities.

Finally, all three doctors emphasize patients should maintain realistic expectations. “I always remind them it’s not a ‘new’ joint, it’s an artificial joint,” Russell says.

McCarthy adds, “There are spectacular developments, giving much greater quality of life than was previously possible. But it’s somewhat presumptive to think any device—be it an artificial joint or a heart valve—can be better than what nature gave you.”

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