California doctors pioneer e-medical records

With some 400,000 patients and the largest medical network in Northern California, Hill Physicians Medical Group Inc. faces a daunting challenge moving from paper to an electronic medical records (EMR) system.

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Its provider network includes 3,000 primary care and specialty physicians working in about 1,600 locations across nine counties, making Hill Physicians the largest independent practice association, or IPA, in the U.S. But instead of being overwhelmed by the process of implementing an EMR system, Hill has become a model for how to replace paper records with electronic records -- it is a taking a very slow, steady approach.

Three doctors' offices in the network came online with the EMR system in 2005, the first year of implementation, and another five have been added so far this year, with the goal of 18 total by year's end.

"It took a year to figure out," said Craig Lanway, chief information officer of PriMed Management, which is Hill Physicians' proprietary medical management company, handling all of the network's administrative functions. "We've made great strides" in moving to electronic records, he said.

EMR systems save administrative costs, providing a more efficient way to store and handle records than paper. EMR also reduces the risk of errors in prescriptions because doctors, who have notoriously bad handwriting, can electronically send prescriptions to pharmacies. But perhaps most importantly, EMR pulls together all of a patients' medical records -- doctors can quickly call up the range of a patients' records, including those from hospitals, consulting doctors and specialists, as well as laboratory and test results. Over time, as more health-care providers move to electronic records, it should be easy for a patient's medical history to follow them as they move to new locations, change doctors or see specialists.

However, doctors haven't flocked to EMR. Some resist change, others are not comfortable with technology in the first place and are not keen to make it part of their practice. Some feel they can't afford to make the switch. EMR systems require that exam rooms be equipped with computers or that doctors carry mobile PCs, such as laptops or tablets or even PDAs (personal digital assistants) as they move from patient to patient.

Hill Physicians, through PriMed, chose an ASP (application service provider) model for its electronic system, with Tellurian Networks Inc. as the hosting site. It also turned to Sun Microsystems Inc. for integration of hundreds of disparate computer systems in place at the various doctor's offices. The SOA (service-oriented architecture) of Sun's SeeBeyond tools, including its eGate integrator and eInsight business process management, offered the scalability Lanway and his team needed. It also provided the Web-based framework to allow Hill's doctors to interface with third-party applications in use across the health-care network. NextGen Healthcare Information Systems Inc. was chosen as the EMR.

Hill Physicians established a committee to work on the EMR project, including which doctors' offices should be the pilot sites, and had a realistic picture of the challenges, according to Wayne Owens, senior vice president of health care at Sun. "Hill has been extremely well educated and well informed. When they came to us, they knew what they were doing," he said. "I think they are a pioneer."

While Lanway said that it has been a "tough learning curve" for doctors because the EMR system is so different from what they have been used to, he has been impressed with how well the system has performed from a technical standpoint. "We have almost no problems with any aspect of this [system] from a technical aspect," Lanway said. "The reliability is just amazing. It's just flat-out amazing."