City's doctors on cutting edge with computer-based records

NEWBURYPORT -- Dr. Richard Traister is well trained in the intricacies of the human body. But his new computer is another matter.

The laptop -- part of a high-stakes revolution in healthcare -- can instantly display a patient's vast medical history while also giving Traister the choice of typing notes during examinations or scribbling in longhand on a swivel screen, with software that transcribes the words immediately into print. Traister opts for longhand because he finds it more conducive to maintaining eye contact with patients.

The software, however, can be cranky. When a 63-year-old patient recently described how his injured right knee stiffens as he sits in the movies, the software interpreted ''movies" as ''remove," forcing Traister to back up and scour the complex options menu to fix the glitch.

''This is a fairly steep learning curve," said Traister, 59. ''But the potential is enormous. It's going to be a great method to enhance patient care."

In mid-March, Traister's Highland Primary Care in Newburyport became the first practice in the city to begin using the electronic records system as part of a $50 million pilot project designed to improve the safety and quality of healthcare. The project will cyber-connect healthcare facilities in three Massachusetts communities, with Newburyport joined by Brockton and North Adams. Instead of cumbersome paper files -- Traister's administrative office is lined with thousands of such records -- each patient will have one electronic file to which all test results from hospitals and outside specialists can be rapidly transmitted. Already, prescriptions in Traister's office can be sent in seconds to a nearby pharmacy.

The goal is to speed lab results, increase consumer access to their health records, and reduce medical errors by eliminating confusing and often illegible doctors' notes. Today, consumers can bank, shop, and even pay taxes online, yet most of their medical records are stuck in paper-bound, century-old filing systems.

''You want physicians to have as complete a medical picture about you as they can before they make a decision about you," said Micky Tripathi, president and chief executive officer of the nonprofit Massachusetts eHealth Collaborative.

With Blue Cross Blue Shield of Massachusetts funding the initial $50 million, the collaborative of 34 hospitals, insurance companies, and health groups selected Newburyport, Brockton and North Adams for its three-year pilot program. Traister's practice is the first of 41 in Newburyport to install and launch its system, with the rest slated to come on line throughout this year. By early next year, Newburyport's physicians, Anna Jaques Hospital, and other healthcare facilities intend to connect with each other.

The collaborative hopes its program will serve as a model for a statewide health information network, but that undertaking is likely to be complex and costly. An initial investment of at least $1 billion would be required to create a statewide system, and there likely would be several thousand physicians still not connected, Tripathi said.

''A good system costs 25 to 30 thousand dollars per physician. That's just the software and hardware. That doesn't include the disruption to your office, your training time, and you may have to reduce your patient load for a while, while you are getting used to the system," he said.

Yet patient advocates say that the medical records system sorely needs such a sea change. As many as 98,000 deaths nationwide occur each year as a result of medical errors, many of them preventable, according to a report by the Institute of Medicine, a component of the National Academies of Science. Healthcare leaders say electronic systems that warn of potentially lethal drug interactions or dangerous dosage levels can save lives.

Several hospitals north of Boston have taken the first steps toward building electronic record systems, based on this potential.

''People talk about an 80 percent reduction in prescribing errors when you write prescriptions electronically. That's why this is the future," said Dr. Mitch Rein, chief medical officer at North Shore Medical Center, which includes hospitals in Salem and Lynn, a cancer center in Peabody, and a women's health center in Danvers.

''If I get a call at night about a patient, I can pop on my computer at home and access the entire record and the records are legible," Rein said.

About half of North Shore Medical Center's 150 primary-care physicians already are connected to an electronic medical records system that links files throughout much of the Partners Healthcare chain, including Massachusetts General and Brigham and Women's hospitals in Boston.

By the end of next year, North Shore hopes to have at least 75 percent of its primary-care doctors and a quarter of its specialists hooked in. All told, the Partners chain, including hundreds of its affiliated physicians, is investing roughly $7 million a year to increase the use of electronic records, Rein said. Eventually, the system will include a component that would allow patients, using a secure password to log in, to schedule appointments, review doctors' orders, and search for test results, Rein added.

Northeast Health Systems, which includes Beverly Hospital and the Addison Gilbert in Gloucester, is on pace to have electronic medical records for 70 percent of patient visits by next March, and hopes to have 30 area physicians' offices using electronic systems by then too, said Northeast's Todd Lowthers.

Still, the chain faces quite a challenge because many of the systems that the physicians are installing can't communicate with each other.

''It's easier to be on one system, but all the practices are independent, so it's having to connect all those systems," Lowthers said. ''That's why it will be a tremendous accomplishment when it's all done."

The Cambridge Health Alliance, which includes Whidden Memorial Hospital in Everett and more than 20 primary-care centers in the region, is aiming to complete an electronic medical records system by July 2007. But the alliance has had a network within its hospitals for eight years that connects many files, including physicians' notes, lab results and medication orders, said Dr. Hilary Worthen, its senior director of clinical informatics. She estimated the alliance has already spent ''tens of millions" on its various systems.

Hallmark Health, which includes Melrose-Wakefield Hospital, has committed $4 million toward a unified records system, but at least 200 affiliated physicians with private practices will have to foot their own bills to hook into it, said Dr. Michael Coffey, a physician who serves on Hallmark's panel setting up the system.

''I think doctors have been resistant to change," said Coffey, 32.

Much of the hesitation stems from concerns over costs and security, Coffey said.

But, he added, ''If the financial world has figured out a way to make it secure, then the health industry can," he said. ''People aren't making money off implementing electronic medical records. We're doing this, and paying money to do this, to improve the quality of care for patients."

Kay Lazar can be reached at klazar@globe.com.