Physiatry Practice Management Resources

Across the country, Boston-based CareGroup Health System has connected its six hospitals and 3,000 health care providers via the Internet.

"In 1997, it became clear that physicians were no longer chained to one location and that they needed secure access to patient information from wherever they were," says John D. Halamka, who simultaneously works as an ER physician at Beth Israel Deaconness Medical Center, chief information officer of CareGroup, and a dean at Harvard Medical School. "The Web is an extraordinary way to do that, particularly with the addition of handheld devices that deliver information wirelessly."

Today CareGroup delivers 100 percent of its lab results over the Internet. "The labs give HL7 feeds to our hospital information system," Halamka explains, referring to an electronic transmission standard that allows computers with disparate programs to communicate with each other.

How security concerns affect online results
The privacy provisions of HIPAA (the Health Insurance Portability and Accountability Act of 1996) require that patients give permission to have their personal health information shared with authorized individuals—and that physicians and other providers restrict access to patient data. These regulations are scheduled to be implemented by 2003.

CareGroup, which gives patients access to their online results, already has an elaborate security system. Each doctor carries a small, token-like device that hooks onto a key chain, displaying a password needed to access the Web site. The password changes once a minute. The system is also equipped with "meta tags" that block users from saving confidential clinical data to their hard discs—and prevent their browsers from saving the data to memory. The online lab reports are available only in look-up mode, with an audit trail that lets patients see who has viewed their test results. A separate, secure e-mail system transmits the reports to CareGroup practitioners in a form that can be electronically downloaded.

The format in which results are delivered may pose a problem for practices that use electronic medical records. For example, Evans Medical Group in Evans, GA, relies on two large labs and one major hospital system for its lab work. But only one of these facilities—LabCorp—furnishes the results in a form that can be automatically downloaded into the EMR of the three-physician pediatric and adult practice. So staffers have to print out e-mailed results and enter them into the EMR.

Medscape, which made the group's EMR, launched a Web-based reporting service more than a year ago, notes internist and pediatrician Robert J. Lamberts. "Now LabCorp exports the results securely to Medscape, and the data are exported to us over a secure Internet link." The next step, according to Hillsboro, OR-based Medscape, will be online test ordering, which should be available soon.

Saving time by ordering tests online
Medical Arts Ob-Gyn, a four-physician group in Utica, NY, has been ordering tests online from a nearby lab called Centrex Clinical Laboratories for the past year and a half. "I used to have to keep a log of everything ordered. Now I just pull a printout at the end of the day," says Zita Graves, who processes lab orders for the group.

Doctors still hand patients written orders to give to Graves, who processes lab orders for at least 36 patients daily. "The biggest timesaver," she says, "is not having to re-enter a patient's name, address, and other identifiers each time a new test is ordered." The software does that for her. The ordering physicians must provide diagnosis and prescription codes, but the electronic ordering system makes sure they match.

Having a lab tech rather than a doctor input an electronic order is consistent with the way other practices use this function—if they use it at all. Cory Fishkin, a product manager for McKesson—which links the Utica ob/gyn group with Centrex over the Internet—says physicians are resistant to ordering labs online if it doesn't fit into their workflow. Melanie Allison, director of integrated solutions for LabCorp, agrees. "Doctors are much more interested in lab results. We care about the round trip," she says. The Burlington, NC-based lab recently added an online ordering function, but has seen little activity so far.

The key problem seems to be that ordering labs on a PC or a wireless device requires changes in physicians' work habits. Merely viewing lab results that arrive electronically doesn't involve any change.

Yet Fishkin points out that clinicians and their staff have much to gain from electronic ordering. Doctors who input data electronically, whether online or in an e-mail message telling a staff member to place the order, eliminate the errors and wasted time entailed in deciphering handwritten orders. No matter who places the electronic order, a practice stands to benefit from the coding check and the reports some labs generate when patients fail to get ordered tests.

As labs and other medical services take to the Web in record numbers, the question remains: When will physicians follow? "When wireless applications become more widespread," Allison predicts. And when there's so much valuable patient information online that practices start using the Internet for clinical purposes.