$50m test seeks to end doctors' paper chase

The daily paper chase begins as soon as Dr. David Howell arrives for work at his pediatrics office in Brockton.

Each child's medical file must be handled seven times for an average doctor's visit. Every day, Howell plows through stacks of paper on his desk. Sometimes, files are misplaced. Specialists who examine his patients send him typed notes, via the Postal Service.

The result? Howell's local Dodge dealer can review the service history on his 2000 Chrysler faster than Howell can check the vaccination record of a 13-year-old heading to summer camp. ''It's frustrating. It slows us down," Howell said.

Howell is eagerly awaiting the launch of a $50 million experiment paid for by Blue Cross and Blue Shield of Massachusetts to fully computerize patient records in healthcare markets in Brockton, North Adams, and Newburyport. It is one of a number of tests nationwide that are being closely watched by the healthcare industry, academics, and politicians who want to correct a broad failing of American medical care: a lack of digital record keeping.

In Brockton, for example, which is the largest test of the three, a diverse array of hospitals, clinics, group practices, and independent physicians' offices will have all of their patient records transferred to electronic format and readied for display in exam rooms and nurse stations. Doctors will review patient histories, order laboratory tests, check for potentially adverse drug interactions, and prescribe drugs.

Physicians at emergency rooms at Brockton Hospital and Caritas Good Samaritan Medical Center, meanwhile, will be able to instantly review a patient's records from any connected doctor's office in the city, regardless of clinical affiliation.

Blue Cross, the state's largest health insurance company, is footing the bill for this pilot initiative because it wants to show electronic medical records will benefit all players in the healthcare system by improving care and reducing costs.

''We really want to prove this is worth doing," said Carl Ascenzo, senior vice president and chief information officer at Blue Cross and Blue Shield.

Some healthcare networks in Massachusetts have already adopted their own advanced electronic-records systems, but only for use within their systems: Partners HealthCare Systems Inc., the Cambridge Health Alliance, and Baystate Health System in Springfield.

In general, independent doctors and community hospitals throughout the country have been slow to computerize medical records systems. Systems are expensive, starting at $30,000 for a physician's office.

''Physicians want to do it, but they are a small business like anyone else and they can't afford the initial expense," said Dr. Alan Harvey, president of the Massachusetts Medical Society.

According to HealthGate Data Corp., of Burlington, a firm that provides clinical guidelines for use on such computer systems, fewer than 30 percent of American hospitals have their own electronic medical records system. Of those, fewer than 10 percent have the most advanced technology, called ''computer physician order entry," which is supposed to alert prescribing physicians to potentially dangerous drug interactions and prevent medical errors.

Concern about the slow pace is growing in Congress. Massachusetts Senator Edward M. Kennedy is among a bipartisan group of senators sponsoring legislation to encourage greater use of electronic medical records. Such programs are seen as a critical to bringing more standardization, accountability, and transparency to healthcare.

But switching to computers can produce logistical headaches for doctors. And some studies have predicted that health insurance companies, not doctors, reap the most immediate financial rewards through the elimination of needlessly duplicated tests and fewer errors.

''The people who are expected to make the investment, doctors, don't see the benefit," said Micky Tripathi, chief executive of the Massachusetts initiative established with the Blue Cross money, called the eHealth Collaborative.

Some estimates put the total cost of wiring healthcare in the United States at $230 billion. In that context, the Blue Cross and Blue Shield of Massachusetts investment is a tiny start. The collaborative received 33 applications from communities that wanted to serve as test markets; the three winners -- Brockton, North Adams, and Newburyport -- were chosen based on their size and the number of different providers.

Beginning in about a year, the collaborative will introduce a common computer network across a number of healthcare providers in each of the three communities. In the meantime, teams are ironing out ways to protect patient privacy, how records will move through the systems, and who will have access. The eHealth Collaborative has selected seven ''preferred" software vendors.

Caritas Christi Health Care System, owned by the Catholic Archdiocese of Boston, plans to use what it learns from its participation through Caritas Good Samaritan in Brockton and apply it to other hospitals in its system, including its flagship, Caritas St. Elizabeth's Medical Center in Brighton.

Joseph Ciccolo, Caritas senior vice president of support services, said the hospital already has in-house automation for radiology and other tests. What's new wiring up doctors throughout the community.

Brockton was a good choice for the pilot because it has a diverse population and a variety of physician practices.

''There's traditionally a lot of competition in Brockton," said Howell. ''If you can do it in Brockton, you can do it anywhere."

Christopher Rowland can be reached at crowland@globe.com.