Rx for the digital divide

The Health Resources and Services Administration recently announced the

launch of a pilot program that will provide Internet-based medical records

for physicians and patients nationwide in HRSA-funded community health centers.

MedicaLogic Inc., Hillsboro, Ore., donated nearly $1 million worth of

its Logician Internet online health record subscriptions and accompanying

laptops, printers and training to 200 health center physicians located at

160 clinics across the country. The Logician system provides doctors with

Medicaid/Medicare-compliant chart notes and secure access to patient data

any time via the Internet.

About 3,000 HRSA community health centers nationwide serve more than

11 million uninsured, underinsured and medically underserved people. By

improving the flow of information to health care providers, this new program

aims to help reduce medical errors — a problem that has received much government

and media attention lately and is currently the eighth leading cause of

death in the United States, said HRSA administrator Claude Earl Fox.

"This pilot program using Internet technology to curb medical errors

is in line with the administration's goal to cut medical errors by 50 percent

in five years," Fox said. "This is the first opportunity for community heath

centers to [partner] with the technology community."

Using the Logician system, physicians can create electronic medical

records by entering text on a keyboard, using voice-recognition tools or

simply pointing and clicking, said MedicaLogic's chief executive officer

Mark Leavitt. Online access should be especially valuable to centers in

rural areas, helping to bridge the now infamous digital divide between technology

haves and have-nots, he said.

The records are kept at a secure data center that requires biometric

identification to enter. All online communications are password protected

and 128-bit encrypted. Leavitt said the system will aid in addressing medical

errors through easily searchable patient records and real-time notification

to doctors of any new medical advisories, such as drug recalls.

"This is the end of illegible prescriptions and illegible or lost charts,"

Leavitt said. "Physicians can find the information they need in a matter

of minutes."

Leavitt said the recent Food and Drug Administration recall of the diabetes

drug Rezulin was a perfect example of how the Logician system can help eliminate

errors. "Within an hour, we sent an e-mail to all of our physicians with

directions for queries on how to identify their patients on the drug....

A list was made and given to a clerk who called the patients that day and

told them what to do."

Leavitt said MedicaLogic's motive for participating in the program was

altruistic and profit-driven.

"We need a critical mass of physicians using the product and talking

about it, and doctors [who] treat underserved patients talk with other doctors,"

he said. "We're giving it to people who wouldn't use it otherwise and getting

them to talk about it."

The company could have donated subscriptions and equipment in other

parts of the medical community, but the health centers were an obvious choice.

"That's where it can have the greatest impact on patient care," Leavitt

said. "The underserved population suffers the most from lost medical records

because they are often mobile or transient and have chronic illnesses....

There's a greater potential benefit for good information in the hands of

doctors."

Over the next four months, HRSA plans to evaluate the pilot program

through weekly client meetings and monthly conference calls with all the

participating clinicians, said Marilyn Gaston, HRSA's associate administrator

for the Bureau of Primary Health Care, the division leading the project.

Based on the success of the pilot, future plans include providing all

HRSA community health centers with a free subscription to the Logician Internet

tool, which normally costs $99 per month per physician.

Patients eventually will have online access to their records and be

able to request prescription refills online. But both the patient and physician

must approve before the patients are granted online access, Leavitt said.

That feature also will help bridge the digital divide because some of the

patients may not have permanent addresses or a home phone number but could

still access their medical records online at a library or community center.

"When you talk about bridging the digital divide, [online] access to

health care information can be one of the best drivers for doing it," Leavitt

said.