Record Time

But taking the information off paper and putting it into computers changes the way that information can be used--much the way loading a company's financial data into a spreadsheet allows a different level of analysis from simply looking at static numbers on paper. Indeed, it changes health care. Hospitals with digital records can, to use Cerner's phrase, "turn their data on its side and look at it from an analytical point of view--every clinical event is treated as a future learning event." Records can be analyzed to find the sources of postoperative infection, or to see if variations in outcomes are related to the course of treatment, the person providing the treatment, or the characteristics of patients themselves.

Cerner's data center, in fact, is rapidly becoming one of the largest repositories of health information in the country. With federal privacy and anonymity rules in place, that wealth of data about patients and their health care could become a rich source of insight, discovery, and treatment improvement.

There is a sense of urgency about digitizing medical record-keeping--one study estimated that 100,000 people in the United States die each year (twice the number killed in car accidents) because of the sort of preventable medical errors that digital medical records help eliminate. A Rand study published last fall (paid for, in part, by Cerner) estimated that at the low end, the United States could save $140 billion a year if digital record-keeping were in place.

The hurdles remain extraordinary. For hospitals, the cost runs to millions of dollars; for a physician practice, the average startup cost is $44,000 per doctor, though the savings that result allow doctors to pay back that investment in about two and a half years. (And Cerner has started offering leasing schemes that require lower up-front investments.) The cultural barriers are equally daunting--for any given hospital or doctor, the easiest thing to do in the short term is to keep using paper. But the benefits of switching are undeniable, tangible, and well worth the cost, say those who have done it. The power of digital records is a reminder that simply changing the medium in which information is stored and shared--without changing the information itself--can radically reshape a profession.

Allen Weiss, an internist and rheumatologist, is president of the two-hospital NCH Healthcare System in Naples, Florida. Back in the early 1990s, the hospitals were using Cerner's software to automate their lab work and results reporting. Over the past five years, they have gradually automated other departments--the emergency room, the pharmacy, the nursing work done on patient floors. Indeed, nurses at NCH hospitals push little laptops on carts from room to room as they make their rounds; the computers use high-speed wireless Internet access that blankets the hospital. The operating room is just about to make the transition to digital record-keeping. Physician charting on patient floors--which is separate from the nursing records and requires separate training--is still done on paper, but will be converted this summer. "Yes, on the patient floors, we have both digital and paper," says Weiss. "It's the worst place to be. But the nurses are now huge advocates of the new system."

Weiss is as unvarnished about the transition as Saleh in North Kansas City. "Nobody had any idea how hard it was going to be," he says. Just recently, the radiology transcriptionists, the people who type reports of exams dictated by radiologists, switched to a new form of digital transcription, and their productivity was cut by 70%--from 2,000 lines of reports a day to 600. "Our transcriptionists, many of them have 30 or 40 years of experience. They were screaming. They get paid by the line. We fell five days behind on radiology reports--and the average length of our hospital stay is four days." Now, though, transcriptionists typically have a doctor's report in the patient's medical record within 10 minutes of the dictation being complete.

Weiss is equally unvarnished about what the Cerner software has done for NCH and its patients: Hundreds of people are not dying because of the hospital's new digital record-keeping system.

Consider one of the chronic problems in treating elderly people in hospitals: bedsores. Elderly people, with less ability to move in a hospital bed, with incontinence problems, with thinning skin, are highly susceptible to bedsores. And the skin infections often prove devastating. "If you are over 75 years old, and you get a pressure ulcer while you're in the hospital," says Weiss, "you have a 50% chance of dying in the next year." Not only that, but treating bedsores costs between $5,000 and $50,000 per patient, depending on the severity.