California doctors pioneer e-medical records

With some 400,000 patients and the largest medical network in Northern California, Hill Physicians Medical Group Inc. faces a daunting challenge moving from paper to an electronic medical records (EMR) system.

Its provider network includes 3,000 primary care and specialty physicians working in about 1,600 locations across nine counties, making Hill Physicians the largest independent practice association, or IPA, in the U.S. But instead of being overwhelmed by the process of implementing an EMR system, Hill has become a model for how to replace paper records with electronic records -- it is a taking a very slow, steady approach.

Three doctors' offices in the network came online with the EMR system in 2005, the first year of implementation, and another five have been added so far this year, with the goal of 18 total by year's end.

"It took a year to figure out," said Craig Lanway, chief information officer of PriMed Management, which is Hill Physicians' proprietary medical management company, handling all of the network's administrative functions. "We've made great strides" in moving to electronic records, he said.

EMR systems save administrative costs, providing a more efficient way to store and handle records than paper. EMR also reduces the risk of errors in prescriptions because doctors, who have notoriously bad handwriting, can electronically send prescriptions to pharmacies. But perhaps most importantly, EMR pulls together all of a patients' medical records -- doctors can quickly call up the range of a patients' records, including those from hospitals, consulting doctors and specialists, as well as laboratory and test results. Over time, as more health-care providers move to electronic records, it should be easy for a patient's medical history to follow them as they move to new locations, change doctors or see specialists.

However, doctors haven't flocked to EMR. Some resist change, others are not comfortable with technology in the first place and are not keen to make it part of their practice. Some feel they can't afford to make the switch. EMR systems require that exam rooms be equipped with computers or that doctors carry mobile PCs, such as laptops or tablets or even PDAs (personal digital assistants) as they move from patient to patient.

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