Despite Challenges, Doctors Take Digital Plunge President Obama's stimulus package includes $19 billion to computerize the nation's health care system, including medical records and prescriptions. Doctors are reluctant to give up the paper system they've relied on for so long, but nonetheless, some of them are rising to the president's challenge.
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Despite Challenges, Doctors Take Digital Plunge

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Despite Challenges, Doctors Take Digital Plunge

Despite Challenges, Doctors Take Digital Plunge

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From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

At his news conference last night, President Obama talked about some of the investments he wants to make in health care and the price tag that's been making many lawmakers nervous.

President BARACK OBAMA: Let's do a whole host of things, some of which cost money on the front end, but offer the prospect of reducing costs on the back end.

SIEGEL: Well, included in that whole host of things are $19 billion to help computerize the nation's health care system. We'll hear about a study out today that shows there's a lot of work to do to get all of our doctors and hospitals booted up.

But first, NPR's Joanne Silberner has this story on what one hospital and one doctor are doing.

JOANNE SILBERNER: Most mornings at Children's National Medical Center in Washington, DC, pediatrician and chief medical information officer Brian Jacobs hangs out outside patients' rooms.

Dr. BRIAN JACOBS (Pediatrician and Chief Medical Information Officer, Children's National Medical Center): So we're around in here with the critical care team and the oncology on a young lady with leukemia.

SILBERNER: These doctors have something that most other doctors in the US don't have: COWs - Computers on Wheels.

(Soundbite of wheels rolling across floor)

SILBERNER: These contain full and up-to-date information about their patients.

Dr. JACOBS: So we're going to move over to the next pod, here and do our next patient.

SILBERNER: Jacobs loves these computers - no more waiting for a patient's X-rays to be delivered, no more wondering what happened to yesterday's notes, no more lost charts. And one more thing…

Dr. JACOBS: One of the nice things about these computers on rounds is if something's coming up on a question in rounds that I really don't really know the answer to, I can sort of cheat here and go over to the Internet.

SILBERNER: And help the patient with the latest information. Parents often join the group, and Jacobs shows them MRIs and blood tests and other information about their kids. Sheryl Post(ph) is at Children's with her daughter, who's just had a bone marrow transplant.

Ms. SHERYL POST: The ability for them to show us those things and talk us to the meaningfulness of those things and to be able to see it is very helpful.

SILBERNER: Wouldn't you rather not know?

Ms. POST: No, no, no, no. No, no, no. Have to know. Have to know. You know, we're being asked to make some decisions and, you know, we're part of the team. We have to be.

SILBERNER: But according to a new study, only 1.5 percent of American hospitals are fully computerized in every department, and just 17 percent of hospitals have their doctors order medications and treatments by computer. Doctor and health IT guy Brian Jacobs is reaching beyond his hospital to pediatricians like Cynthia Fishman. She practices 20 miles away in Maryland. Fishman has convinced the seven other doctors in her practice to buy into the Children's system. She argued that they'd not only be able to access their own records more efficiently, they'd also be able to find out everything that happened to patients in the hospital. But she does admit…

Dr. CYNTHIA FISHMAN (Pediatrician): I'm nervous about technology today. For instance, I walked in, and we're now transitioning our computers to the new system, and they were down. So I'm a little nervous that, had today been a day where I supposed to see patients and need a computer, that the computer would not have been functioning.

SILBERNER: She admits you can lose a paper file, but it's somehow worse to lose a computer file. The Children's system does come with IT support, but Dr. Jacobs feels Dr. Fishman's pain.

Dr. JACOBS: There are real fears, here, particularly for somebody who is very well seasoned clinician who has been delivering excellent care for years and years and years on paper.

SILBERNER: But in her Maryland office, Dr. Fishman has concerns that go beyond whether the computers work.

Dr. FISHMAN: I'm a little fearful that when I'm using a computer and a laptop, I will look at the laptop and not the patient.

SILBERNER: She's also worried about the cost. Children's is giving Fishman and her colleagues a huge discount as an incentive to get them into the system. Instead of charging each doctor $20,000 for the software, they're paying $6,600. But there's still hardware. There's still upkeep. Most of Obama's stimulus money is going to doctors who have electronic medical records for their Medicare and Medicaid patients. Fishman doesn't have any of those patients. She says her eight doctor practice may spend as much as $200,000 to gear up, and she doesn't know if they'll recoup the cost.

Dr. FISHMAN: It will not change payments, no. So it's pure cost to us. What we're hoping is that this will be a break even situation.

SILBERNER: With saving some things like paper, and most importantly, storage of old records. The office is lined floor to ceiling with charts - sometimes legible, sometimes not. She pulls one out.

Dr. FISHMAN: What it takes is somebody writing the various illnesses down.

SILBERNER: Who's handwriting is this?

Dr. FISHMAN: This is one of my partners. I can read it because I know his handwriting.

SILBERNER: For the record, I can't.

Fishman uses the word hope a lot. She hopes they won't lose money. She hopes the system will work. She's going ahead for one reason.

Dr. FISHMAN: I think it will improve patient care.

SILBERNER: Her office will, she hopes, be up and running with computerized medical records on May 6th.

Joanne Silberner, NPR News.

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