Ask Dr. Hallberg: Electronic medical records

It's been almost two years since President Obama targeted $19 billion in stimulus money to help medical facilities convert to electronic record-keeping. The technology is intended to improve the quality of care and reduce costs.

But the conversion has been slow. Only about 1 in 4 doctors have made the switch.

This week in Washington an Institute of Medicine committee will take a fresh look at health information technology and how to make the system safe and effective.

MPR's Steven John spoke with Dr. Jon Hallberg about e-records. Hallberg is a physician in family medicine at the University of Minnesota and director of the Mill City Clinic in Minneapolis.

Steven John: Almost every other industry has welcomed electronic records. Why is it taking so long for the medical industry to get on board?

Dr. Jon Hallberg: Medicine as a whole is very ... conservative in the way that they don't want to jump on the latest thing. And so it's just taken a long time, I think, to realize the benefit that might be there. However, I really think the cost is just incredibly prohibitive ...

I think when we live in the Upper Midwest, in Minnesota in particular, and you've got such dominance with the Mayo Clinic and places like HealthEast and Fairview and Health Partners and the like, we're all in. Most of us in the Upper Midwest are employees of large health organizations, big clinic groups. But if you go to a place like Florida, I mean most everybody's in it for themselves. There's an absolute geographic difference here, too.

So I think if I was a small practice, and I'm used to writing things on paper, it'd really be hard for me to be sold on why I should switch over, if I have to spend thousands and thousands of dollars to make this happen, if the system works. And for medium-sized groups, you're talking about millions of dollars to invest in this. That's just something you can't do very quickly or lightly.

John: Why is it considered so important to get more doctors converted to electronic record keeping?

Hallberg: I think that we're going from almost a 19th century technology. In clinics I've been in and clinics I've gone to will have a manila folder with loose papers in there. On some level, that seems incredibly unsafe, insecure, just there's something about that that is very old. And there's something comfortable about that because you can just take a piece of paper, you can take a lab result and stick it in there, but they get lost. Someone takes the chart home, which they shouldn't be doing. It gets lost in medical records. I mean there's all kinds of reasons why it's just sort of a bad idea.

With electronic health records, people who need to see the information can see it instantly, and you don't misplace it. It's always there. And I can think of many cases where I think it's improved patient safety in that I know what the medications are. If I try and prescribe a medication that they have an allergy to, I'm alerted to that. I'm blocked from writing a prescription.

I mean the list goes on and on. So I think it's many eyes that need to have access can have it, whereas with a paper chart, it's just one chart, and you've got to get that to the people. And so it just seems incredibly old-fashioned at this point.

John: What about the issues of security and privacy concerns with electronic records? There's always that hacking risk. Somebody might get into somebody's records who shouldn't.

Hallberg: Well, I've heard more concerns from more people about the security with an electronic record than I ever did with paper records, but the fact of the matter is that every time you access someone's chart, you're leaving a cookie, basically. I mean someone can find out who looked at that person's records. You could never do that with a paper chart. You don't know who's looking through your paper chart.

I've got some patients who are extremely conscious about who has access so that even when I'm somebody's primary care provider, I have to sort of break glass. I have to ... say that this is who I am. I need to provide this person's care, and I break that electronic glass, so to speak, and then will access that person's chart. But I personally, in doing this every day, I have no problem at all having my own information in an electronic record. I think it's safer than it was when it was on paper.  

(Interview edited and transcribed by MPR News reporter Madeleine Baran.)