More medical providers are moving to computerized patient records to allow better tracking, access and communication

Gone is the patient chart, dangling from the end of the hospital bed. Gone is the white board hovering over the chaotic emergency room, pictured in so many hospital-themed TV shows with doctors and nurses struggling to treat patients despite minimal information on their medical history.

Gone, because the age of shared patient information through computerized networking is, at long last, infiltrating delivery of medical services from hospitals to doctors offices.

Now, Kaiser Permanente's Dr. Mindy Shapiro consults a medical history databank -- available through mobile units nicknamed COWS, or computers on wheels -- just before she visits a hospital patient and settles into practicing her best beside manner.

"It's all there," says Shapiro, a pulmonary specialist and medical director of the critical care unit. "Every surgery, every hospitalization, every prescription written. Blood-sugar levels. Vital signs. And what they ate for breakfast."

Since Kaiser is a members-only health plan that integrates its clinic services, doctors' offices and hospitals, it's got the ability to record and retain a wealth of patient information.

In June, that information became available in Kaiser Santa Rosa's medical offices and hospital through its HealthConnect system. In November, Kaiser launched HealthConnect's service for members, called "My Health Manager," which allows members to use the Internet to make appointments, view their latest lab test results, refill prescriptions and even e-mail their family doctor.

"We flipped the switch and have gone from paper to digital," said Dr. Bob Schultz, medical director of Kaiser facilities in Sonoma County. "We don't have to give doctors handwriting classes anymore and we don't have to chase down the nurse to find the patient's chart."

Kaiser's competitors in Sonoma County, Sutter Health and St. Joseph's Memorial Hospital, also have been moving toward their own versions of electronic health records.

For doctors practicing at Memorial, St. Joseph two years ago implemented a digital picture archiving system that makes radiology services available via computer anywhere in the hospital and to physicians outside with special access. And for doctors affiliated with St. Joseph, a Web-based portal called Physician Connect was set up so medical providers could view a patient's medical records of hospital visits, medications and test results.

Memorial's medical director, Dr. Gary Greensweig, said St. Joseph has completed the first phase of electronic patient record keeping for Sonoma County patients, which involves digitizing nursing evaluations. The next phase, involving clinical documentation, medication administration and physician orders, is scheduled to go live in late summer, he said.

"It is not just a matter of computerizing all the things we do manually," Greensweig said. "We have to redesign the information because we want to avoid inefficiencies in our paper records. One thing for sure is that you are never quite done."

In June, the 57 physicians in the Sutter Medical Foundation North Bay will be linked through a system that tracks a patient's medical history. Currently, a patient's medical information is stored in paper files at different medical offices or on computers that can't communicate with each other.

"The vision is for Sutter physicians and hospitals to have just one record on their patients," said Dr. Steve Levenberg, president of Sutter Medical Group of the Redwoods. "We are early adopters . . . on the second wave of innovative technology that will benefit patients from more informed clinical decisions and better coordination of care."

Levenberg said Sutter medical groups in Sacramento, Palo Alto and Modesto integrated their records in a single electronic system last year. By the end of the summer, Levenberg said the 50,000 to 70,000 patients seen by Sutter doctors in Sonoma County will have their records in a single system in which physicians can view everything from lab results to X-rays to notes from specialists.

All three local health care providers are early adopters of electronic patient records within their respective systems.

Santa Rosa's Kaiser facilities were the second, behind those in Sacramento, to launch HealthConnect for providers and members. Kaiser's facilities in Walnut Creek are scheduled to implement HealthConnect this month, with several more facilities in Northern California to follow in 2008. By 2010, all of Kaiser's Northern California medical offices and hospitals should be connected.

"This was a beta test site, so everything that we do here is going to be copied somewhere," said Kate Gonnella, a veteran nurse in Kaiser's emergency rooms.

Gonnella said nurses are finding the information available through HealthConnect to be invaluable as they make their rounds, check on patients and dispense medication. Nurses use a scanner to read bar-code bands on patients' wrists, which triggers the screen on the mobile computer to summon patient information.

"It tells you whether it is the correct medication and whether it is being given at the wrong time," Gonnella said.

Medication mix-ups have long been a liability problem for hospitals, with errors often resulting in expensive litigation and sometimes irreversible harm to the patient.

Schultz acknowledged that, like physicians everywhere, Kaiser doctors were somewhat reluctant to leap so completely into the virtual vortex. Much of medical practice relies on face-to-face contact and a personal relationship with patients that cannot be approximated through e-mail.

"Some critics call it cookbook medicine," Schultz said. "We see it resolving so many situations where doctors can't find the lab results, where patients play phone tag with their physicians and where patients don't have a co-pay on questions that could have been taken care of through e-mail."

Schultz estimates some 42,000 of the 130,000 members assigned to Kaiser's Sonoma County facilities are using the HealthConnect system, just three months after its launch. One major advantage for patients is their ability to check for themselves on their doctor's advice and other medical history, such as their immunization schedules or their history of allergic reactions.

"People only remember about 10 percent of what their doctors tell them" during an office visit, Schultz said.

In the emergency room, a complete picture of patient information becomes crucial because on-the-spot decisions have to be made, according to Dr. Gerry Lazzareschi.

"In the emergency department, doctors and nurses need a good sense of what everyone is doing for a patient and that white chart on the wall didn't help us manage the chaos," Lazzareschi said. "We spent a lot of time looking for the clipboards and hearing patients ask 'Don't you guys talk to each other?' "

Using HealthConnect, Lazzareschi said, the medical staff is able, with the patient still in the room, to hand the patient lab test results, arrange for a visit to a specialist and give them a printout of services performed and medication they need to take.

You can reach Staff Writer Bleys W. Rose at 521-5431 or bleys.rose@pressdemocrat.com.