How Electronic Medical Records are Changing Health Care

Intro: MemorialCare Health System, excellence in healthcare presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Hello, everybody. Welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. David Lagrew, a maternal-fetal medicine specialist and chief integration and accountability officer for MemorialCare Health System. Dr. Lagrew completed medical school in his residency at the University of Kentucky in his hometown of Lexington. He then came to Southern California for a maternal fetal medicine fellowship at Long Beach Memorial Medical Center and the University of California, Irvine. Following fellowship, he joined the faculty at the University of Louisville before returning to California to become the medical director at the new Saddleback Women's Hospital in 1988. He continues to practice at Saddleback Memorial and has also taken on the role of Chief Integration and Accountability Officer to lead MemorialCare's implementation and use of electronic medical records. That's a mouthful and it's a full day for Dr. Lagrew. Welcome, sir.

David Lagrew, MD: Hey, thank you, Deb.

Deborah Howell (Host): Today's topic is how electronics medical records are changing health care. My dad was a physician and he fought, fought, fought the whole thing, but now in retrospect he says that's a very good change.

David Lagrew, MD: Yeah, we hear a lot of that.

Deborah Howell (Host): Of course, he's in his 80s now, so things have changed dramatically since he retired at 75. So first of all, what is an electronic medical record?

David Lagrew, MD: Well, I think the best definition would be that it's a paperless clinical record or chart, including things such as provider notes, ordering systems, and then clinical results like laboratory values and x-rays.

Deborah Howell (Host): Is there anything that you can put in the electronic medical record that you can't put in a regular paper folder?

David Lagrew, MD: You know, there are. For example, some of the new imaging types that we do, like CT scans and MRIs, You never could get all of those images into a paper or into a film format that was convenient to read, whereas now we can just pop open a window and look through and see all those hundreds of images at once.

Deborah Howell (Host): Very cool. That's one benefit to the patients. What are the other benefits to the, I guess we'll just call them EMRs.

David Lagrew, MD: Right, right. Well, there's a huge number of benefits. Overall, it improves patient care. Here at MemorialCare, we have an interesting story in the sense that we started our best practice protocols way back in 1996. And we actually spent a few years at that time making up protocols, putting them on paper, trying to maintain them in that format. And what we found through that process is you just couldn't keep up with the changes and the distribution of, of all this best practice content and get it out to everyone. And as well, we couldn't get the results back of our care. And now that we've gone digital, so to speak, what it allows us to do is very quickly make changes and get them out to the point of care. And also now we're beginning to be able to extract all our results and then improve the care on the fly. So I think that's the biggest thing that leads to less medical errors. And I think the biggest thing is that allows the providers and really now the patients that broad view of all their medical information.

Deborah Howell (Host): Let's just take a typical example. Say I go to my GP and I get a chest x-ray. In the old days, they had to FedEx that thing over to the surgeon. And in some cases it got lost along the way and it was the only one, and so a new one had to be taken. So bring us now into the world of electronic medical records. How would that be done today?

David Lagrew, MD: Yeah, so today essentially the image would be taken. It would be digital. There wouldn't be any film. The image would immediately be available to all the providers for review. And as soon as the radiologist wrote their interpretation, that would be in the system. So in the example you gave, if I was the family medicine doctor who ordered it, could instantly see the results as well as all the specialists that that patient sees, that would immediately be available.

Deborah Howell (Host): So the whole team gets to weigh in simultaneously before any action is taken. Okay. That is great.

David Lagrew, MD: Yeah, I think, again, it's one of the big changes you see in the electronic world that, as you say, you simply couldn't duplicate in the paper world.

Deborah Howell (Host): So we have the doctors having access now, but how are the medical records accessed by the patients?

David Lagrew, MD: So we have what we call a patient portal, which is an informatics term. And what that means is my view, let me put on that patient hat because we're all going to be patients. Think of that. I can now look into a good deal of my medical record and see it. So that immediately brings me into my care team. So I can look over the information. Is my medication list correct? Have they gotten all my allergies? Is my history of surgeries and previous medical problems up to date? And it as well allows us to then communicate directly between the provider team, nurses, doctors, et cetera, and the patients themselves. So it really sort of opens up the 24-7, 365 availability of the care team. And it becomes a two-way street.

Deborah Howell (Host): I mean, how many times have you been sitting on the cold table in your gown and they're hiding the chart from you? You just want to see what your blood pressure is, you know?

David Lagrew, MD: Exactly. Well, you know, and what we always tell people, and because you kind of, you know, hit the nail on the head earlier with your dad's story, that the fact of the matter is that we as providers need to understand that you're talking about a patient who has the most skin in the game, who really it matters the most to that they see and interact with their own information.

Deborah Howell (Host): Right. Now, we're all very wary of our own personal computers and such when it comes to security. Are there any security issues with EMR?

David Lagrew, MD: Well, obviously there are. I mean, if you think about it, you know, what do you want to protect for your bank account or your health information? And the correct answer is we want to protect both of them. So we literally take this very seriously that patient privacy rights have to be protected. We've put in numerous workflow measures such as passwords and encryption and We've spent a lot of money on our networking systems, any computer that has any kind of access to the clinical data set. And, of course, obviously the data centers we have have to be sort of state-of-the-art companies, security to prevent hackers and things of that nature getting into the information.

Deborah Howell (Host): It becomes almost a political thing, too, when candidates are very protective. Maybe they have a little high blood pressure and they don't want their constituents to know because they're coming up for re-election. You have to make sure the right people are having access.

David Lagrew, MD: Yeah, the average person doesn't want, may not want their employer to see certain things or other family members. So, you know, it's interesting. It's only a very small, small number of patients who feel extremely passionate about it, you know, probably 2-3%, but you have to protect their rights too. And so we're always doing this balance between, you know, who can see the information and who I, as a patient, want to see that information against weighing it against making it available to enough members of the team so that they can look at it and respond appropriately.

Deborah Howell (Host): Like everything else, a fine balance. So how do you see EMRs changing health care in the future?

David Lagrew, MD: Well, you know, we sort of look at, you know, if you sort of summarize what's going on in healthcare reform, it's really into quality, it's into value, in other words, giving efficient care, in other words, good outcomes, but at the lowest cost. And really, for other industries, you know, that has almost uniformly meant moving to sort of digital methods. And for me, I think it kind of gets back to what we were talking about a little earlier. What it is is now we're going into an age of medicine where we're practicing team medicine, which includes the patient themselves, and a type of medicine where we only want to practice when we can see the whole thing, the whole view of the patient's record. We don't feel comfortable as we did in the paper world, although I would say we've never felt quite comfortable only seeing our little portion of the data.

Deborah Howell (Host): And I'm going to stop you there, Dr. Lagrew, because we are out of time. Unbelievable. It's gone so fast. But I want to thank you so much for talking to us today about EMR systems. And quickly, do we have a website where people can find more information?

David Lagrew, MD: Sure. If they'll go to our website on memorialcare.org, they'll find the information they need.

Deborah Howell (Host): Yes. Thanks again. It's been a real pleasure, Dr. Lagrew, for having you on the show, and we wish you a truly good life all this day and every day to come. I'm Deborah Howell. Join us again next time for our Weekly Dose of Wellness. Have a great day.