SEATTLE- Heart surgery resident Alex Farivar is 30 hours into his shift at the University of Washington (dossier) Medical Center when he finishes his rounds and retreats bleary-eyed to the residents' room with a handful of barely legible notes that detail patients' conditions.
In the past, these notes would have gone straight into Farivar's patients' files, leaving subsequent caregivers to puzzle over his handwritten observations and directions. Instructions that were still unclear might have led to a time-consuming round of phone tag as doctors and nurses tried to clarify what Farivar jotted down. Worse, his notes might have been misinterpreted and patients given the wrong treatments.
Now, instead of adding to the sheaf of papers in a 70-year-old heart patient's chart, Farivar sits at a computer in the small room where residents catnap and calls up an electronic version of the woman's medical record. Made by Seattle-based Elixis, the WebCoder online medical record provides a complete - and readable - treatment and medication history. Farivar adds his observations and directions for treatment by clicking on a series of menus with titles like Vital Signs (VITL), Current Medications and Assessment and Plan, then digitally signs the record. Authorized doctors and nurses can access the record online from any location.
"Before, I would have scribbled this, leaving off 25 percent of the information," says Farivar, 26. "Some of it would have been completely illegible." He picks up a piece of paper and scrawls his signature. "Someone who was consulting on the case would have looked at this and said, 'Who is this?' It's not uncommon to page two to three people just to find the right person."
And it's not uncommon for mistakes to be made. Charles Jaffe, a San Diego allergist, witnessed early in his career the consequences of bad handwriting when a hospital's medical staff misread another doctor's instructions for administering chemotherapy to a child. "I was the physician on call and they cried for help, 'What are we going to do? We've given 10 times the dose,'" recalls Jaffe, who now uses an online medical record made by Hillsboro, Ore.-based MedicaLogic.
Recent research indicates that as many as 98,000 people in the U.S. die each year just in hospitals as a result of medical errors. A report released in December by the National Academy of Sciences' Institute of Medicine estimated that death by medical mistake is a leading cause of death in the U.S., with more people dying from medical errors each year than are killed by AIDS, breast cancer or car accidents. The death toll is equivalent to a jumbo jet crash every other day.
Figures like those have fueled interest in online medical records as a way to reduce mistakes caused by bad handwriting, improper drug prescriptions, misuse of medications or incomplete information on patients' conditions.
Further impetus has been added by a Clinton administration proposal that would require doctors and hospitals to report medical errors to the states. If approved, such a mandate could drive more doctors to adopt online medical records as a way to collect information and reduce preventable medical mistakes, say health care industry observers.
Previous electronic medical records, or EMRs, never caught on because they generally used proprietary technology that was expensive to buy and maintain. But the Internet has stirred new interest in EMRs, with the prospect that any doctor with a Net connection and a Web browser can access an online medical record.
Still, the online medical record industry remains in its infancy. A dozen physicians are testing an EMR from iMedica that runs on handheld devices. Only about 1,000 doctors use Elixis' WebCoder. MedicaLogic declined to say how many doctors have signed up for its Logician Internet online medical record, but about 8,000 physicians use an intranet version of the product. The growth of the industry will depend on how fast doctors take to the Internet to practice medicine.
