Computers that talk to docs transform medicine

A few years ago, Dr. Alison Peterson might not have noticed if one of her patients skipped an appointment. Or forgot to fill a prescription. Or missed an important lab test.

Now, all she has to do is ask her computer.

And if, by chance, she tries to prescribe a drug that could cause an allergic reaction, her computer may flash a warning: Are you sure you want to do that?

At Peterson's office in Cottage Grove, the old patient charts have been replaced by the latest in medical technology: an electronic record system that's ushering in a whole new era in medicine.

Once mainly a high-tech way to track doctors' orders and patient visits, the newest generation of electronic records popping up across the Twin Cities seems to have a virtual mind of its own.

It not only stores information, it also eagerly prods doctors to make decisions based on the newest research. Clinics throughout Minnesota are scrambling to convert to the pricey systems.

The Allina clinic where Peterson works, for example, scrapped its yellowing paper files for an electronic system a year ago.

Now Peterson, a family physician, can call up the chart of a patient with pneumonia or heart disease, and see experts' tips on the best way to treat it.

She can push one button to see what questions to ask, and another to find out what medications are recommended.

Ideally, she shouldn't even have to worry about potential drug interactions because an alert should pop up and warn her if she tries to prescribe drugs that don't mix well.

"In the old days, I'm flipping through [files] looking for when the last test was," said Peterson, who has practiced medicine for 13 years. Now, she said, she can find what she needs in an instant, including checklists to make sure she doesn't forget anything important. "That is huge," she said.

Some worry this kind of technical wizardry could strip medical care of its human touch.

"The risk is that you focus on filling in boxes, rather than in carefully listening to a patient," said Dr. Jerome Groopman, a professor at Harvard Medical School and author of "How Doctors Think."When doctors have their eyes on a computer screen as opposed to a patient ... you can miss a lot of things."

Critics complain that electronic charts can be cumbersome and that patient data may be incomplete or inaccurate.

But supporters say electronic records are making health care safer and more effective. One big advantage, they say, is that doctors won't have to rely on memory to keep up with the latest medical advances.

"It's gotten to the point [that] the knowledge that's out there is too much for any individual to manage," said Dr. Brian Patty, an emergency room doctor and electronic records specialist at HealthEast. The average family doctor, he noted, may see 100 different medical conditions. "There's no way somebody can remember or keep up on the reading to know what's best for each of those conditions."

With electronic records, "we can embed these things," said Dr. Penny Wheeler, a chief clinical officer at Allina, and put them at the doctor's fingertips.

A patient's experience

For Peterson, who didn't know how to type, it was a bumpy transition.

At first, she resented having to fill out the electronic record during every patient visit instead of dictating notes for someone else to transcribe.

But she discovered that electronic charts gave a "much richer picture" of her patients. For the first time, she could see all their test results at once.

So when Mary Stoskopf of Cottage Grove arrived for a diabetes check in late September, Peterson could quickly spot the change in her blood-sugar levels ("Indeed, you've made a big improvement there, so well done," she said.). She also tilted the screen toward her patient, explaining "it enables them to look at all the things I'm looking at."

The electronic chart will highlight problems (in this case, a missing microalbumin test), and walk Peterson through a list of talking points (such as aspirin and eye exams to prevent complications).

In the past, Peterson figures, she did most of those things about 80 percent of the time. Now, she said, "it won't let me out of here until I've done this."

If she's not sure what to do, she can click a tab called "SmartSet" -- a kind of medical crib sheet. It guides doctors through unfamiliar territory, such as which drugs experts might choose for similar patients. That's a boon for young doctors, she said, but even veterans like her can learn something. "I love this," she said.

Cookbook or gold standard?

Skeptics call it "cookbook medicine ... but it really isn't," said Patty, of HealthEast, which is installing a similar system at its hospitals and clinics.

Doctors still make the decisions, but now they have help, he said. HealthEast hired medical experts to scour scientific literature and update the "best practices" every six months.

In the past, doctors have been notoriously slow to adopt new treatments. One recent study found it took 17 years to get a proven heart drug into widespread use, Patty said. "This day and age, that delay is unacceptable," he said.

Groopman, one of the skeptics, admits there are advantages. "It's very seductive to have the first symptom fit into a decision tree," he said, but that can be misleading. Patients may talk about one problem, when something else is really bothering them. "So if you're not inputting the real clues or the real symptoms, then you're going down the garden path," he said.

But Dr. Michael Aylward, 32, an assistant professor at the University of Minnesota, says critics who complain that it's a rigid system miss the point.

"I think that's one of the purposes, it should always be rigid," said Aylward, an advocate of electronic records. "If you've been practicing for 20 years or if this is your first day, you should still be ordering a patient's antibiotics and testing in the same guideline-based, evidence-based way. That's the gold standard of care and everybody should be held to that."

Still, electronic records have met some resistance locally. There are some holdouts who say "over my dead body," and won't use computers, said Patty, of HealthEast.

Some complain of costs -- which can be in the millions for big systems and in the tens of thousands for small practices.

Dr. Terry Cahill, a family doctor in Blue Earth, sees potential, but complains of "warning fatigue" from too many unnecessary interruptions. "It's too sensitive," he said of his clinic's new system, although he expects that to change.

For many, the appeal is obvious. "Nobody wants to make mistakes," said Dr. James Dehen, a Brainerd surgeon and president of the Minnesota Medical Association. "As long as it's done right and done in concert with the physicians, it should be looked on as a complement, not a headache."

Maura Lerner • 612-673-7384

Maura Lerner • mlerner@startribune.com