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PITTSBURGH -- Baby Riley Matthews wheezed noisily on the exam table. "He's belly-breathing," the emergency-room doctor said worriedly -- Riley's little abdomen was markedly rising and falling with each breath, a sign of respiratory distress.
In most emergency rooms, the doctor would grill Mom: Has he ever been X-rayed? Do you remember what it showed? But in the new all-digital Children's Hospital of Pittsburgh, doctors just clicked on a COW -- a "computer on wheels" that rolls to each patient's side. Up popped every test and X-ray the 6-month-old has ever had.
This is the eerily paperless hospital of the future, what the "electronic medical record" that President Barack Obama insists will transform what health care looks like.
No chart full of doctors' scribbles hanging on the bed. No hauling around envelopes full of X-rays. No discharge with a prescription slip. Even the classic ER patient list has changed from the white-board of TV-drama fame to a giant computer screen.
By the best count, only 1.5 percent of the nation's roughly 6,000 hospitals use a comprehensive electronic record.
Even that statistic belies how hard it will be for health care to jettison its 19th-century filing system by 2014, the federal government's goal -- despite the $19 billion that the economic stimulus package is providing to help doctors start. It took Children's seven hard years and more than $10 million to evolve a system that lets its doctors check on patients with a few mouse clicks from anywhere and use speedily up-to-date records in directing their care.
Studies show electronic medical records, or EMRs, can greatly improve the quality of patient care and reduce errors. Children's has seen medication errors drop 45 percent since it started automating in 2002. But hospitals won't necessarily recoup their investment, because a patient who goes home sooner means lost revenue.
"Our health care system has not valued quality and efficiency," said Dr. David Blumenthal, the Obama administration's new health IT director.
So Congress added a stick to the carrot of the stimulus money: Health providers that aren't digital enough by 2015 will start losing Medicare dollars. Blumenthal told The Associated Press he's seeing a sudden surge in interest.
Children's moved from a decades-old building to a new hospital in May, a final step in its digital journey. One wing is inpatient, the other houses offices for specialists' outpatient care, all linked by the "eRecord."
Some 4,000 computers line the halls. Nurses swipe patients' wristbands with bar-code scanners to see when it's time for medication, and then match the bar-coded dose to the prescription.
In the intensive care unit, computer "dashboards" automatically graph patients' vital signs and other readings from monitors and lab tests -- letting nurses spot at a glance a drop or spike that signals a patient about to get in trouble, instead of rifling pages of a paper chart to tell.
And the giant patient database lets health IT chief Dr. James Levin spot practices that need improving. He found too many doctors ordering specially filtered blood transfusions, at $30 extra a bag, when medical guidelines say few patients truly need them.
The big hurdle: Most of today's EMRs can't be read by the computers at another doctor's office or hospital across town.
Children's aimed for a community approach, with the eRecord available at all 20 University of Pittsburgh-affiliated hospitals. More than 100 primary-care doctors in western Pennsylvania are adopting it.
But just three miles down the road, Dr. Kristin Hannibal illustrates the hitch. Her 60-pediatrician practice is affiliated with Children's but only partly digital. She logs in to check on hospitalized patients, but must scan her own patient checkup information into the eRecord. And her practice next year is buying a competing company's software, one it deemed better suited for outpatient use. The systems don't read each other.
"We are far better off than we were even five years ago when there was no ... access," Hannibal said. "It's just we have another big step to make."
