Selected Podcast
How Electronic Medical Records are Changing Health Care
As CIAO, Dr. David Lagrew, MD speaks about EMR systems in general and how they benefit patients. He also describes how they are changing the health care field and the way patients and providers interact.
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Organization: myMemorialCare
Dr. Lagrew's bio
Dr. David Lagrew, MD
Dr. Lagrew completed medical school and 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.Organization: myMemorialCare
Dr. Lagrew's bio
Transcription:
How Electronic Medical Records are Changing Health Care
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 and 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. Dr. David Lagrew (Guest): Hey, thanks, Deb. Deborah: Today’s topic is how electronics medical records are changing healthcare. 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.” Dr. Lagrew: Yes, we hear a lot of that. Deborah: Of course, he’s in his 80s now, so things have changed dramatically since he retired at 75. First of all, what is an electronic medical record? Dr. Lagrew: 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 clinical results, like laboratory values and x-rays. Deborah: Is there anything that you could put in an electronic medical record that you can’t put in a regular paper folder? Dr. Lagrew: There are. For example, some of the new imaging types that we do, like CT Scans and MRIs, you never could get over 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: Very cool. That’s one benefit to the patients. What are the other benefits? Well, I guess, we’ll just call them EMRs. Dr. Lagrew: Right. Well, there’s a huge number of benefits. Overall, it improves patient care. Here at MemorialCare, we have interesting story, in the sense that we started our best practice protocols way back in 1996. We actually spent a few years at that time making up protocols, putting them on paper, trying to maintain them in that format. What we found through that process is that you just couldn’t keep up with the changes and the distribution of all this best practice content and give it out to everyone. As well, we couldn’t get the results back of our care. 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. Also, now we’re beginning to be able to extract all our results, and then improve the care [once] applied. I think that’s the biggest thing that leads to less medical errors. I think the biggest thing is it allows the providers—and really now the patient—that broad view of all their medical information. Deborah: Let’s just take a typical example. Let’s 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. In some cases, it got lost along the way, and it was the only one, and so a new one had to be taken. Bring us now into the world of electronic medical records. How would that be done today? Dr. Lagrew: Yes. 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. As soon as the radiologists wrote their interpretation, that would be in the system. In the example you gave, if I was the family medicine doctor who ordered it, I could instantly see the results, as well as all the specialists at the page. That would immediately be available. Deborah: The whole team gets to weigh in simultaneously before any action is taken. That is great. Dr. Lagrew: Yes. It’s one of the big changes you see in the electronic world that, as you say, you simply couldn’t duplicate in a paper world. Deborah: We have the doctors having access now. How are the medical records accessed by the patients? Dr. Lagrew: We have what we call a patient portal, which is an informatics term. What that means is—let me put on the patient’s hat, because we’re all going to be patients, Deb, if you think of that—I can now look into a good deal of my medical record and see it. That immediately brings me into my care team. I can look over the information: Is my medication list correct? Have they got to know my allergy? Is my history of surgeries and previous medical problems up to date? It as well allows us to then communicate directly between the provider team—nurses, doctors, etc.—and the patient themselves. It’s really sort of opens up the 24/7/365 availability of the care team. Deborah: It becomes a two-way street. I mean, how many times have you been sitting on a 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. Dr. Lagrew: Exactly. Well, we always tell people, because you kind of 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 [in] in the game, who really it matters the most to, that they see and interact with their own information. Deborah: 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? Dr. Lagrew: Well, obviously, there are. I mean, if you think about it, what do you want to protect, your bank account or your health information? The correct answer is we want to protect both of them. We literally take this very seriously that patient privacy rights have to be protected. We put in numerous workflow measures, such as password and encryption. We spend a lot of money on our networking system, any computer that has any kind of access to our clinical data set. And, of course, obviously the data centers we have do have state-of-the art securities to prevent hackers and things of that nature getting into the information. Deborah: It becomes almost a political thing, too. Candidates are very protective of -- maybe, they have a little high blood pressure, and they don’t want their constituents to know because they’re coming up for reelection. You have to make sure the right people are having access. Dr. Lagrew: Right. Of course, the average person may not want their employer to see certain things, or other family members. It’s interesting. It’s only a very small number of patients who feel extremely passionate about it, probably 2 – 3 percent, but you have to protect their rights, too. So, we’re always doing with balance between who can see the information and whose eyes the patients want to see that information, again, weighing it against making it available to enough members of the team so that they can look at it and respond appropriately. Deborah: Like everything else, a fine balance. How do you see EMRs changing healthcare in the future? Dr. Lagrew: Well, we sort of summarized what’s going on in the healthcare reform. It’s really into quality; it’s into value, in other words, giving efficient care, in other words, good outcomes that is the lowest cost. And really, just like other industry, that is almost uniformly meant moving to digital method. For me, I think it kind of gets back to what we’re talking about a little earlier, what it is, is now we’re going to an age of medicine where we’re practicing team medicine, which includes the patients themselves, and a type of medicine where we only want to practice when we can see 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 can never feel quite comfortable only seeing our little portion of the data. Deborah: I’m going to stop you there Dr. Lagrew because we are out of time—unbelievable, it’s gone so fast—but we want to thank you so much for talking to us today about EMR systems. Quickly, do we have a website where people can find more information? Dr. Lagrew: Sure. If they’ll go to our website on memorialcare.org, they’ll find the information they need. Deborah: Thanks, again. It’s been a real pleasure, Dr. Lagrew, for having you on this 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!
How Electronic Medical Records are Changing Health Care
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 and 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. Dr. David Lagrew (Guest): Hey, thanks, Deb. Deborah: Today’s topic is how electronics medical records are changing healthcare. 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.” Dr. Lagrew: Yes, we hear a lot of that. Deborah: Of course, he’s in his 80s now, so things have changed dramatically since he retired at 75. First of all, what is an electronic medical record? Dr. Lagrew: 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 clinical results, like laboratory values and x-rays. Deborah: Is there anything that you could put in an electronic medical record that you can’t put in a regular paper folder? Dr. Lagrew: There are. For example, some of the new imaging types that we do, like CT Scans and MRIs, you never could get over 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: Very cool. That’s one benefit to the patients. What are the other benefits? Well, I guess, we’ll just call them EMRs. Dr. Lagrew: Right. Well, there’s a huge number of benefits. Overall, it improves patient care. Here at MemorialCare, we have interesting story, in the sense that we started our best practice protocols way back in 1996. We actually spent a few years at that time making up protocols, putting them on paper, trying to maintain them in that format. What we found through that process is that you just couldn’t keep up with the changes and the distribution of all this best practice content and give it out to everyone. As well, we couldn’t get the results back of our care. 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. Also, now we’re beginning to be able to extract all our results, and then improve the care [once] applied. I think that’s the biggest thing that leads to less medical errors. I think the biggest thing is it allows the providers—and really now the patient—that broad view of all their medical information. Deborah: Let’s just take a typical example. Let’s 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. In some cases, it got lost along the way, and it was the only one, and so a new one had to be taken. Bring us now into the world of electronic medical records. How would that be done today? Dr. Lagrew: Yes. 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. As soon as the radiologists wrote their interpretation, that would be in the system. In the example you gave, if I was the family medicine doctor who ordered it, I could instantly see the results, as well as all the specialists at the page. That would immediately be available. Deborah: The whole team gets to weigh in simultaneously before any action is taken. That is great. Dr. Lagrew: Yes. It’s one of the big changes you see in the electronic world that, as you say, you simply couldn’t duplicate in a paper world. Deborah: We have the doctors having access now. How are the medical records accessed by the patients? Dr. Lagrew: We have what we call a patient portal, which is an informatics term. What that means is—let me put on the patient’s hat, because we’re all going to be patients, Deb, if you think of that—I can now look into a good deal of my medical record and see it. That immediately brings me into my care team. I can look over the information: Is my medication list correct? Have they got to know my allergy? Is my history of surgeries and previous medical problems up to date? It as well allows us to then communicate directly between the provider team—nurses, doctors, etc.—and the patient themselves. It’s really sort of opens up the 24/7/365 availability of the care team. Deborah: It becomes a two-way street. I mean, how many times have you been sitting on a 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. Dr. Lagrew: Exactly. Well, we always tell people, because you kind of 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 [in] in the game, who really it matters the most to, that they see and interact with their own information. Deborah: 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? Dr. Lagrew: Well, obviously, there are. I mean, if you think about it, what do you want to protect, your bank account or your health information? The correct answer is we want to protect both of them. We literally take this very seriously that patient privacy rights have to be protected. We put in numerous workflow measures, such as password and encryption. We spend a lot of money on our networking system, any computer that has any kind of access to our clinical data set. And, of course, obviously the data centers we have do have state-of-the art securities to prevent hackers and things of that nature getting into the information. Deborah: It becomes almost a political thing, too. Candidates are very protective of -- maybe, they have a little high blood pressure, and they don’t want their constituents to know because they’re coming up for reelection. You have to make sure the right people are having access. Dr. Lagrew: Right. Of course, the average person may not want their employer to see certain things, or other family members. It’s interesting. It’s only a very small number of patients who feel extremely passionate about it, probably 2 – 3 percent, but you have to protect their rights, too. So, we’re always doing with balance between who can see the information and whose eyes the patients want to see that information, again, weighing it against making it available to enough members of the team so that they can look at it and respond appropriately. Deborah: Like everything else, a fine balance. How do you see EMRs changing healthcare in the future? Dr. Lagrew: Well, we sort of summarized what’s going on in the healthcare reform. It’s really into quality; it’s into value, in other words, giving efficient care, in other words, good outcomes that is the lowest cost. And really, just like other industry, that is almost uniformly meant moving to digital method. For me, I think it kind of gets back to what we’re talking about a little earlier, what it is, is now we’re going to an age of medicine where we’re practicing team medicine, which includes the patients themselves, and a type of medicine where we only want to practice when we can see 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 can never feel quite comfortable only seeing our little portion of the data. Deborah: I’m going to stop you there Dr. Lagrew because we are out of time—unbelievable, it’s gone so fast—but we want to thank you so much for talking to us today about EMR systems. Quickly, do we have a website where people can find more information? Dr. Lagrew: Sure. If they’ll go to our website on memorialcare.org, they’ll find the information they need. Deborah: Thanks, again. It’s been a real pleasure, Dr. Lagrew, for having you on this 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!