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MEETING THE MINDS - DR. JOHN HALAMKA

His goal: Computerized patient records

A few years ago, Dr. John Halamka's grandmother died and his quest to computerize medical records became personal.

Halamka had pressed for electronic medical records years earlier and won awards for developing cutting-edge technology for CareGroup, which includes Beth Israel Deaconess Medical Center. But when his grandmother died, in part, he believed, from a medical error, he became even more driven to hasten the day when every patient's health records are available on a computer, able to be accessed by doctors anywhere.

Now, Halamka, the 42-year-old chief information officer of CareGroup and a former emergency room physician, is helping to shape federal discussions about how to move hospitals and doctors away from pen and paper, and to link health records nationwide -- overhauls that proponents say would save money and reduce medical mistakes. Researchers have estimated that there are anywhere from 98,000 to 195,000 preventable deaths each year because of medical errors.

"That would be like a 747 crashing every single day, killing everybody on board," Halamka said.

A fuller record of Halamka's grandmother's past treatment might have saved her life, he said. At the time, a doctor in rural Wisconsin did not know she was already taking steroids for her arthritis and prescribed a powerful form of ibuprofen. The combination, Halamka said, caused a bleeding ulcer. His grandmother's blood pressure dropped and she had a terminal stroke.

"It's hard in medicine to keep track of best practices and drug interactions," Halamka said. "But, today, if you tried to do that in our system, it wouldn't let you."

Indeed, Halamka imagines doctors nationwide someday tapping into networks not unlike the one at Beth Israel, where physicians write prescription orders on computers that double-check them against current best practices. With a few strokes of a keyboard, doctors also can pull up a patient's old MRIs, prescriptions and other medical records. And thousands of patients in the network e-mail their physicians, access their own health records through the Internet and get lab results online.

As the head of information systems at CareGroup and also at Harvard Medical School, Halamka is responsible for making sure that these computerized systems run smoothly. He's also the brains behind developing cutting-edge information technology to help doctors and those in training. He typically works from 5 in the morning to about 9 at night.

Luckily for him, he doesn't need much sleep. Halamka said he gets by on about three or four hours a night, and has his wireless communicator handy at all hours in case of a technological emergency.

Even his wardrobe is designed to accommodate the hectic and often unpredictable lifestyle. Halamka wears black only. "I can grab clothing at 3 a.m. and it will match," he explained.

"He answers the phone in the middle of the night as if he's just at his desk," said Halamka's wife, Kathy, who attributes her husband's stamina to his medical-school training.

On weekends, he hikes and goes mountain climbing. Sometimes he and his wife and 11-year-old daughter, Lara, scour the woods for mushrooms, a hobby that over the years has made him an expert. Although he no longer treats patients, he is consulted any time someone in New England reports having eaten a mushroom suspected to be poisonous.

His expertise in mushrooms provides a glimpse into Halamka's varied resume. Despite his passion for computerizing health records, he hasn't always made his living that way. While an undergraduate at Stanford University, he ran his own financial-software company and later owned a winery. After medical school and a residency at a Los Angeles hospital, where he created an on-line medical record, he joined the faculty at Harvard Medical School and the emergency department at Beth Israel.

Halamka, then an emergency-room doctor, was tapped for the chief information officer job at CareGroup in 1998, not long after he received his master's in medical informatics and designed CareWeb as his thesis project.

His first task was to connect the electronic systems for Beth Israel and Deaconess hospitals, which had merged in 1996. Later, CareGroup added its Mount Auburn and New England Baptist hospitals to the network. Under Halamka, CareGroup developed a system for doctors to order drugs and lab tests through computers that also check for bad drug interactions and problematic treatments. In 2001, the electronic network was named the nation's best in health care by Information Week magazine.

Just when all seemed to be going well, Halamka and his technology team got a very rude awakening in 2002. Beth Israel's computer system crashed repeatedly for nearly four days, forcing the hospital to resort to paper-based systems and runners to deliver lab reports and prescriptions. The problem: A virus released into the network caused a flood of data that resulted in the paralysis.

After the network was rebuilt, Halamka traveled around the country telling the hospital's story to other organizations with gigantic computer networks that could be vulnerable to similar problems.

"That's the kind of guy he is," said Paul Levy, president and chief executive officer of Beth Israel Deaconess. "A different kind of person would have tried to hide it."

At Harvard, Halamka has put all of the medical school's curriculum on the Web and developed a state-of-the-art "virtual patient" program that allows students to "treat" conditions they haven't yet encountered in person, said Harvard Medical School dean Joseph B. Martin.

Lately, Halamka has been making nearly weekly trips to Washington. He's helped review federal grant applications from hospitals wanting to update their information technology. He's involved in discussions about privacy issues and electronic health records. And he serves as an adviser to a committee charged with helping the nation meet President Bush's goal of ensuring most Americans' health records are kept electronically within 10 years.

He does all of this with an eye toward the day when no one's grandmother will die because a doctor didn't know which drugs she was taking already.

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