Dr. Dan Heslinga shows patient Taz Buan-Sugai the Web page for, where his patients can view their medical records. Heslinga is holding a wireless tablet PC that will replace an old laptop computer system that he now uses.

Docs push high tech

A Hawaii physicians group offers
grants to help doctors switch over
to electronic medical records

When Dr. Dan Heslinga, a Honolulu family practice physician, began using an electronic medical records system in 1998, only 1 percent of physicians nationally were using them. Today, somewhere between 10 percent and 20 percent of physicians are believed to be using EMRs.

Despite the increase, the move by physicians to do away with paper-based medical records and convert to EMRs has hardly been a stampede, Heslinga concedes. Hawaii physicians, like their counterparts in other states, have been slow to embrace the idea.

Part of the problem is that early versions of the technology weren't user-friendly, Heslinga said.

"It's not enough to design a system that only makes sense to the people who designed it," he said.

There also is the time and expense of converting to such a system, training staff and worries about whether local tech support will be available, he said.

But within the next year or two, as many as 50 percent of physicians nationally are predicted to make the move toward EMRs, Heslinga said.

"People have been waiting for EMRs to mature. I think that has happened. We are basically there," he said.

Another, more pressing reason for more doctors to convert to EMRs is because the federal government is eventually likely to require it as a condition for participation in such programs as Medicare.

With the future in mind, Heslinga is part of a move by the Hawaii Independent Physicians Association, a 700-member doctor organization that plans to give grants of $3,000 to its physician members who are willing to implement an electronic medical records system.

The initial cost of an EMR system is around $6,000, said Bill Donahue, consulting director for the organization. Ongoing support and software licensing costs should run around $500 per month for the average physician practice, he said.

While the grants are there to assist Hawaii IPA members, the technology is available to any Hawaii physician, Donahue said. Hawaii IPA also will ask the state's health insurers to contribute toward the move. It plans to sponsor legislation to give physicians state tax credits for investing in medical information technology and will be asking medical malpractice insurers to give a premium discount to physicians who implement EMR systems.

The organization also has gone into a joint venture to form a medical technology company called NexMed IT. Its partner in the venture is technology company NexPhase Inc., headed by Philip Curtis.

Curtis said the EMR system called "Logician" uses Oracle-based software for its database. For that reason, it should be compatible with larger hospital and pharmacy systems being implemented nationwide.

The conversion to an EMR system is likely to be a lot less painful than most doctors would think, Curtis said.

Initially, key medical information for patients scheduled to be seen in the next 30 days would be the first to be entered into the system. With the improvements in technology, it's now possible to electronically scan in old medical records, thus cutting down the time it takes to create the EMR.

Instead of a chart, doctors and their staff would enter medical information using a wireless personal digital assistant, or PDA, about the size of a notepad.

Heslinga said an EMR is more efficient than maintaining a paper medical record. For example, using a paper system, a doctor writing a prescription also would record it in the physician notes, as well as adding the name of the drug to the patient's list of medications posted in the chart, he said.

"Right now, (a prescription is) a triple entry. With an EMR you enter it once," he said.

Doctors also can create a system to remind them which patients, especially those with chronic illnesses such as diabetes or high blood pressure, need certain tests on a routine basis.

"It can be set up to remind you of all the things patients are due for," he said. "For example, it can do data mining and will show me all the diabetics who need their blood checked. So there is better patient management both individually and as a group."

Heslinga believes that Hawaii physicians are now ready to embrace the EMR technology.

"Just about everybody is comfortable with computers now," he said. "Most people have gone through that transformation where they no longer see it as a nuisance or a threat, and they've already made the transition in other contexts, like making an airline reservation or buying something online.

"Now we are actually to the point where this technology can make their workday more productive and rewarding."


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