Statewide medical records planned

Blue Cross & Blue Shield of Massachusetts plans to spend about $50 million to electronically link doctors, hospitals, and other healthcare providers in three Massachusetts communities, allowing them to share and access patients' medical records.

Blue Cross and more than 25 other insurers, hospitals, doctors and medical industry groups have formed a nonprofit organization with the goal of building a statewide electronic medical record system. Blue Cross, which has earned record profits in recent years, said it will donate $50 million to test the project next year in three cities or towns.

Doctors who study medical errors and quality of care believe electronic medical records will substantially improve healthcare. Done right, they allow doctors spread out in various offices and hospitals to call up a patient's complete medical history, allergies, test results and prescriptions -- even though many different physicians have treated and tested the patient. These systems also can send doctors alerts to follow up on negative test results with further testing and warn them when they prescribe a drug to which a patient is allergic.

Right now, most doctors keep patients' records on paper in filing cabinets. Many don't have access to records when their patients received treatment from another doctor. Even hospitals and doctors groups that have sophisticated electronic medical records can look up only their own records but generally can't see their patients' test results and treatment from other hospitals and doctors.

''These records are sitting in hundreds and hundreds of separate silos right now," said Elliot Stone, executive director of the Massachusetts Health Data Consortium and a member of the new coalition.

''The healthcare system is rather far behind," agreed Ronald Preston, Massachusetts secretary of Health and Human Services. ''You show up in the emergency room in the middle of the night, and you have a whole host of pre-existing conditions. The emergency room doctors should have the ability to look up your records and know they're accurate."

A big obstacle to building these systems has been money. The cost is $10,000 to $30,000 per physician, including hardware, software, training, and transferring existing records from paper to computer, said Dr. David Bates, chief of general medicine at Brigham and Women's Hospital and a leading researcher on electronic medical systems and medical errors. Many physician practices are just breaking even, and in surveys doctors say they can't afford electronic medical records.

Another issue is that companies that sell these systems have been financially unstable, and many of their systems don't talk to each other, creating a fragmented situation even in cities where hospitals and doctors have electronic medical records.

That's where Blue Cross comes in. The new coalition believes the insurer's $50 million donation will allow them to create a medical record system in three communities, covering about 2,000 physicians plus hospitals, pharmacies, and possibly nursing homes and community health centers. The group's goal is to solicit proposals and decide which test projects to fund by early next year. Preston said the state also may allocate money for the project. The group, which includes representatives from Tufts Health Plan, the state, and Partners HealthCare, will then evaluate the test sites and use the lessons to expand statewide, an ambitious goal that could cost hundreds of millions of dollars.

Bates said that two US communities have developed large-scale electronic medical records: Santa Barbara, Calif., and Indianapolis. He said these systems help reduce medical errors.

In one study Bates conducted, requiring physicians to order patients' medications electronically -- a potential component of computerized medical records -- reduced serious medication errors by 55 percent in the hospital. Brigham and Women's also has installed an alert in its records that warns doctors when a patients' lab test is abnormal, leading to quicker treatment.

But broader issues exist, and some people worry that the increased transparency will lead to less privacy. ''We as a society need to decide how we feel about our health information being moved around," Bates said.

Doctors generally are given a password to get into an electronic medical record system, but they are on the honor system to look up only records for their own patients. Brigham and Women's monitors who looks up patients' records, and giving a password to someone else is grounds for dismissal. Harvard Vanguard Medical Associates, a large multi-specialty physicians group that works closely with Brigham and Women's and has had electronic medical records for nearly two decades, recently allowed some Brigham attending physicians and residents access to the medical records of Harvard Vanguard patients, who often are admitted to Brigham and Women's for hospital care.

Dr. Richard Marshall, Harvard Vanguard chief medical officer, said as electronic medical records become more prevalent, care will improve. But ''we will now have a broader range of people who have access to our records. That's the trade-off."

Liz Kowalczyk can be reached at kowalczyk@globe.com.