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
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
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
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
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. Zallen said the Harvard system,
the most sophisticated now in use, has changed the way he
practices medicine, cutting out time-consuming searches through
erratic paper records, sharply lowering the risk of error in both
diagnoses and prescribing drugs and providing immediate,
up-to-date information for other clinicians. …