Every patient knows the drill. Walk up to the window, tell the nurse your name, take the clipboard and seek out the comfiest seat in the waiting room while you try to recall every allergy and ailment you and your ancestors have had.

Of course, that’s a best-case scenario. Worst-case scenario you’re rushing to the hospital in an ambulance while a medic tries to extract your medical history from a panicked wife or husband. Recounting medical history is the first step for any patient, but this seemingly most simple of chores isn’t always that easy, compromising a doctor’s ability to figure out what to do next for the patient.

“It affects everything you do for them and your ability to diagnose them properly,” said Dr. Linda Van Deusen, a doctor in Bryson City with Carolina Mountain Medical.

The problem goes beyond unconscious patients. Even the most lucid of patients can’t easily regurgitate biopsy results or even what medication they are on beyond “a little yellow pill.”

“So many times when I’m in the emergency room, I would like to know clearly someone’s history and they don’t know it themselves,” Van Deusen said. “Sometimes it is a memory issue. Sometimes people haven’t fully understood what they’ve been told by doctors or what they had done. It gets lost in translation.”

Soon, this simple but major challenge for the medical community — and for patients — will be a thing of the past. A model initiative to share patients’ medical records through an electronic database was announced last week during a press conference at Haywood Regional Medical Center.

Called WNC Data Link, it will connect 16 hospitals — including the hospitals in Franklin, Sylva, Bryson City, Cashiers/Highlands, Cherokee and Waynesville and reaching all the way to Rutherfordton and Spruce Pine — as well as doctor’s offices throughout that same territory. It’s the first undertaking of its kind in the nation and will serve as a model for other regions.

“We were searching for an efficient and effective way to share patient information — within each hospital and across our broad region,” David Rice, CEO of Haywood Regional Medical Center, announced at the unveiling of the new database. “It will enhance patient care throughout Western North Carolina. When a physician is dealing with a major heart attack, he wants to know the patient’s history.”

The database will allow doctors to access the medical records of every patient treated at a hospital or seen by another physician in the region. If a person from Franklin gets in a car wreck in Haywood County and ends up at Haywood Regional, doctors could pull up the patient’s medical history in the new database and discover everything from whether the patient has diabetes, high blood pressure or recently underwent gastric by-pass surgery.

Federal funding for the initiative was secured by U.S. Rep. Charles Taylor, R-Brevard.

“Connectability is vital to provide life-saving health care in the future,” Taylor said at the press conference.

Despite the technology age, electronically sharing medical records between doctors and hospitals and vice-versa has yet to catch on in the nation.

When a trauma patient is transferred from one hospital to another, the patient serves as their own courier, often unbeknownst to them. Photocopies of their medical charts tucked into a manila envelope are sent along in the ambulance or medical helicopter, explained Mark Leonard, CEO of Harris Regional Hospital in Sylva.

Leonard said the initial assessment and stabilization of a patient produces reams of reports and charts, from CT scans to lab work, which don’t need to be repeated when the patient gets where they are going, such as a trauma patient being transferred from Harris in Sylva to Mission Hospitals in Asheville.

“We are most interested in optimizing care,” Leonard said. “But it will also reduce redundant costs.”

Having access to the patient’s records electronically before they arrive can give doctors a jump start on care, said Dr. Richard Lang, a radiologist at Haywood Regional Medical Center.

“In the old days, the patients would come to our emergency room with a big stack of films and papers we would plod through,” Lang said. “If we had all that information ahead of time before they arrived, we could take them right into the room and begin to treat them.”

Lang said having access to vital patient history, like whether they are on blood thinner or have an allergy to X-ray dye, will be invaluable.

“Believe it or not, people forget these things quite a bit,” Lang said.

Martin Wadewitz, the CEO of Angel Medical Center in Franklin, said the system also will help doctors keep up with patients checked in to the hospital.

“A doctor from his home or office could sign on to the system if he had a patient in the hospital, look at lab values, look at radiology dictation, and if he sees something that doesn’t look right he can pick up the phone and call the nursing staff,” Wadewitz said. “It will give him a better idea of the patient’s picture and care that is going on.”

While only hospitals and doctors in Western North Carolina will contribute their medical records to the system, hospitals and doctors in other parts of the county could be given access to view it. For example, a second-home owner who spends time both here and in Atlanta will be able to share with their doctor back home work they had done here.

 

Overcoming Logistics

Hospitals have been working on the WNC Data Link initiative for five years. A major hurdle for WNC Data Link was writing a program that was compatible with every hospital’s computer system. There are umpteen different formats used by hospitals and doctors for their medical charts. One hospital might list a patient’s medications first while another lists allergies first. Hospital leaders realized early on it was impractical to ask hospitals and doctors to change their recordkeeping system and use a standardized form. To make WNC Data Link a reality, a program would have to merge all the systems into one standard interface and extract the information with no extra work to nursing staff, Rice said.

“It’s a simple concept, but a complex system,” Rice said.

IBM was hired to come up with such a program.

“Somehow or another, through the magic of computers, they are able to draw out the information,” said Wadewitz, the CEO of Angel Medical in Franklin.

Gail Gulinson, vice president of the IBM health care division, said a digital database for patient records of this scale has not been attempted before.

“What we’ve got going on here in Western North Carolina, frankly, is leading the pack nationwide,” Gulinson said.

Another hurdle for WNC Data Link was patient privacy and a doctor’s desire to protect their patients’ records.

“Each provider needs to know their information is secure and isn’t being peeked at by their competitor,” said Mike Drake, CEO of Access Point, a technology firm involved in developing the system.

Each doctor will receive a user name and password to access the system. Every medical record a doctor views and how long he spends viewing it is recorded by the computer system. If a doctor looks up a patient who isn’t theirs, it will highlight that doctor’s activity in the database.

While an emergency room doctor can’t be bothered phoning a patient’s primary doctor for permission to check the patient’s records, the primary physician would be able to see who had tapped into their patient’s records, when and for how long, and could follow up on it if they desired, explained Gary Bowers, executive director of the WNC Health Network.

“It’s constantly identifying and tracking exactly who is looking at that record,” Bowers said, adding that it is actually more secure. “With paper records, you don’t know who has looked at it.”

 

Down the road

Possibilities for WNC Data Link in the future are boundless. The system could one day include pharmacists who want to see what other medications a patient is on before filling a prescription with the potential for severe reactions. Ambulance drivers could be included in the system one day. As wireless Internet access advances, a medic en route to a 911 call could research the history of the patient they are on the way to treat, saving critical seconds when they arrive on the scene.

Patients could also be included in the system, with access to only their own records of course through a personal user name and password.

Drake said today’s generation is a more active participant in their medical care than before, especially with the ability to research your own ailments on Internet medical sites. Drake said he has had colonoscopies and prostate cancer screening that he would like to see the results of first hand.

“I want to start seeing some of the results and know the provider is up to speed,” Drake said.

And one day, there will likely be a time when all hospitals in the country can tap into information so a patient’s medical history is available to them no matter where they travel or move.

“In rural Western North Carolina, we are putting together a system that is the future of tracking patient records electronically nationwide,” Rice said.

Haywood Regional Medical Center, Angel Medical Center, and the hospitals in McDowell and Rutherford counties will implement WNC Data Link in coming months. All hospitals in the region will be on board by the end of 2006. Doctors offices will be able to join the system in 2007.

Hospitals in the first phase will be holding staff meetings with doctors to go over the system and conduct demonstrations on its use.