By Glenn Rifkin
N.Y. Times News Service
BURLINGTON, Mass. _ Dr. Barry G. Zallen, a pediatrician at the Harvard Community Health Plan center in Burlington, turns to the Apple Macintosh on his desk, steers the cursor to a patient's name and clicks, and a five-year-old girl's record appears.
Zallen, who has no computer background, instantly gets a detailed account of the girl's chronic cough, the medication he prescribed, her medical history and a list of her previous visits.
Through a central computer, Zallen's colleagues also have access to these records, so they all share up-to-date data on each of the center's 7,300 patients. Cumbersome, often illegible paper records stuffed into file folders have been banished.
The computer does not stop there. It also walks the doctor through the diagnosis of a variety of illnesses by setting out a list of symptoms. It enables Zallen to send prescriptions to the center's pharmacy and order diagnostic tests. It tracks every prescription and test result and alerts him if a patient doesn't fill a prescription or have a test. It reminds him of allergies or other conditions. All this goes into a data base that could later provide valuable information for researchers.
"This is the future," Zallen said.
But that future has been a long time coming. The health care industry has been very slow to enter the information age, but it could be ready to make the leap. A number of big facilities, like the Mayo Clinic in Minnesota, are investing in systems like Harvard's. With costs soaring and reform in the air, the time is certainly ripe: it is estimated that $40 billion to $80 billion could be saved annually if such computerized record systems come into wide use.
Interest has heated up in the past year, under rising pressure to cut costs and improve quality. President Clinton's calls for managed competition accelerate the need for hospitals, practices and clinics to become more efficient. Many realize that despite the initial costs, computerized records are not a technical luxury but an economic necessity.
"Only 1 or 2 percent of health care facilities have started toward this," said Everett Hines, an analyst with Coopers Lybrand. Those that do not do it "will be taken over by more aggressive competitors or disappear."
Justifying the costs is a tough order.
"If you go to a local hospital and ask what they'll save, they can't show you the numbers," said Dr. Paul Carpenter, who is in charge of setting up the Mayo Clinic system. "There are so many intangibles."
But the savings would be enormous. The systems could feed information into nationwide data bases, which could then be studied to determine which treatments work. This invaluable evidence would enable doctors to eliminate unnecessary exams and surgery.
The systems could eliminate the need for repeating tests when results are lost.
True, many hospitals have computer systems, mostly for accounting. But it is a long way from this to a nationwide data base.
One obstacle is the catchup costs. The industry is paying the price for ignoring information technology's potential for three decades. While most industries spend up to 6 percent of revenues on data systems, health care devotes barely 1 percent.
In addition, there are privacy concerns. Patients worry about confidentiality if there is such wide access to intimate details, and many local regulations inhibit the use of electronic records. But proponents say computerized records actually offer far more security, with passwords and encryption technology, than paper records, which are easily misplaced or removed.
Physicians tend to err on the side of caution. If information is missing from a record a test will be reordered or a patient will stay longer in the hospital. …