In many doctor's offices they are still there - the walls of horizontal filing cabinets floor to ceiling, filled with thousands of manila folders with color codes.
These days, those cabinets are disappearing, sometimes quickly, sometimes slowly. The health care system, from small doctors offices to multi-hospital system, is moving those records to electronic form.
"It's a big job," said Phyliss Teter, interim chief information officer for the OSU Medical Center. OSU has converted many of its out-patient records to electronic form. Now it's working on converting its in-patient hospital records. It will cost the medical center tens of millions of dollars and take more than two years.
"It's like replacing all your electrical wiring, your PC, your dishwasher and your refrigerator, and everything that runs from power in your house in the same day and hoping it works," said Teter.
OSUMC, Ohio Health and the Mount Carmel System are all in the process of converting to electronic medical records (EMRs). They are transferring millions of files, integrating scores of different computer systems and converting hundreds of doctors offices. Where they stand in the process varies. But they all are about half way and they expect to complete the task in 2012.
The goal is to have each patient's medical history available at the click of a mouse. Ohio Health vice president Dr. Murnal Shah is overseeing his system's electronic transition.
"A chart on paper locked in a cart somewhere is not going to help ED physician do the best thing then can for you having that available information at the point of care at the moment you need it most is absolutely the scenario we are trying to build towards," said Shah.
Dr. David McClure of Ohio Health has for the most part gone paperless.
"I generate my letter, messages to my staff, prescriptions; all of that is done out of the electronic medical records," he said.
He was in private practice in 2006 when he converted. Now he's part of the Ohio Health System. He says he would not go back. Instead of spending up to an hour and a half a day filling out paperwork, he enters it into a computer as he sees patients. That extra 90 minutes he now spends with patients. Compared to other industries, like banking for instance, healthcare is slow to the electronic conversion. As a system, the United States finds itself far behind other counties when it comes to electronic health records. A Commonwealth Fund survey found while American use of electronic records has doubled in the past three years, less than half of American doctors are using them. In the Netherlands, New Zealand, Australia, and the UK, at least 95 percent of doctors store health information on computers.
One reason for the disparity is those countries have nationalized health care. The other, not unrelated, issue is cost. In the U.S., hospitals are asked to pay for electronic records and on average, it costs a large system $50 million. But it's the insurance companies that reap the greatest financial benefit.
"So really, the brunt of the cost versus the benefit acquisition is not equal," said OSU's Phyllis Teter.
Hospitals do save money with e-records billing efficiency, the elimination of transcription costs and reduced errors. Patients benefit with better monitoring, quicker doctor visits and quick access to medical information in an emergency.
Mount Carmel chief information officer Cindy Sheets said money is not the driving factor for hospitals.
"I tend to look at this as the right thing to do for patient care; it's not about how much money you save," Sheets said.
To help hospitals and doctors with the cost, the federal government promises millions of dollars in stimulus money - $44,000 per doctor and millions of dollars in other incentives. Health care providers have until 2013 to prove they've made the switch.
Hospitals and doctors welcome the money but Mount Carmel's Cindy Sheets worries that the rush to meet the deadline will cause unforeseen problems.
"As a technologist, I worry that we've put a carrot out there that's going to incite a lot of people to implement systems that are really crappy," she said. And then there is the electronic medical records nirvana getting competing hospitals to share information with each other. Experts agree that will come after each system gets their own system in order.
