With their ability to improve patient care, cut costs, and create new workflow efficiencies, electronic health records are finally fulfilling their promise. Add to the medical landscape the U.S. mandate to create electronic medical records for everyone by 2014, and it's no wonder that so many providers are vigorously expanding their healthcare IT initiatives.

Consider the example of St. Luke's Health System in Boise, Idaho, with its four hospitals and 30 outpatient centers. After replacing paper charts with an ambitious Web-based physician portal, doctors and other clinicians no longer need to be on-site to access patient data. They can do so from anywhere with Internet access and at any time. By reducing the paperwork at St. Luke's emergency room, the number of ER patients who saw a doctor within 30 minutes jumped from 55 percent to 81 percent, a dramatic step forward for patients.

St. Luke's improvements in patient care highlight the great strides the healthcare profession can make using technology to empower practitioners. With costs rising fast, caregivers are pressed to save money wherever possible but without eroding patient care. Software solutions that are affordable, flexible, and compliant with government regulations enable healthcare providers to both cut costs and improve customer care at the same time.

The market for electronic medical records (EMR)—which includes medical history and test results as well as decision support services—will reach nearly US$5 billion by 2015, according to market research firm Kalorama Information (see chart, "The Coming Growth Spurt for EMR"). That's a fourfold leap from the $1 billion spent in 2005, the New York City firm reports.

So far, only 23 percent of healthcare organizations have adopted EMR. But legislation from HIPAA, the U.S. Health Insurance Portability and Accountability Act, "makes it a foregone conclusion" that growing numbers will do so, says Bruce Carlson, associate publisher for Kalorama. HIPAA mandates the establishment of national standards for secure electronic healthcare records and transactions.

Cost remains an important factor in the adoption of new technologies. A typical medical record infrastructure requires software, workstations, servers, PDAs, and mobile PCs. But solutions based on widely available office software means greater affordability—and the returns on electronic records investment are dramatic, for physicians as well as hospitals.

"Time and cost savings close the deal," says Carlson. "If you look at a small group practice, activities like chart pulls, transcription, and lab test results cost serious time and money." With electronic records, he adds, doctors' offices "are saving hundreds of thousands of dollars and increasing efficiency."

Electronic records systems are a powerful tool for assisting primary care physicians. Unfortunately, much of what is on the market today is still far too expensive for many primary care practitioners. That's because insurance reimbursements for cognitive services tend to be low. Primary care doctors don't do a lot of the procedures which typically pay far better, says Dr. Bill Crounse, Microsoft worldwide health director. The cost of running a medical practice-including wages, insurance, equipment, and rent-accounts for 60 percent or more of most practices' gross billings. Expenses at many practices reach as high as 85 percent, he points out.

"There's tremendous inefficiency, redundancy, and paperwork," says Crounse. "There's a lot of stuff bogging down the system that technology could make much better."

Using technology to help practitioners provide better specialty services is one area showing promise. For instance, Upper Chesapeake Health installed speech technology to help caregivers provide better service to deaf and hard-of-hearing patients. The system converts hospital staff's speech into several formats, including video sign language. This reduces the need for translators and makes for quicker and more accurate assessments.

"Patient satisfaction is crucial," says Marty Knutson, general counsel and compliance officer for the Maryland, USA, healthcare provider. It also gives Upper Chesapeake Health a competitive edge. "People come back to a place where they are treated well," adds Knutson. "In our experience, assistive technology makes very good business sense."

"By making technology lower cost and more mobile, we're making great strides," says Crounse. "You can see it in the adoption of handheld PCs, improved voice navigation, and the range of devices to make data input easier. We're on the verge of cracking the code on the kinds of solutions clinicians really need."

Crounse says that appropriate use of technology could help eliminate up to 30 percent of today's office visits, mainly encounters by people seeking information or reassurance from a doctor. With fewer patients to see in person, doctors and nurses can spend more time with patients who need the extra attention. For example, appropriate use of e-mail and online video visits could provide many patients with the information and reassurance now available only through traditional office appointments.

"Technology certainly cannot replace all visits, nor should it," says Crounse. "But it could go a long way in augmenting people's needs for information and certain kinds of medical services."

When electronic records reach critical mass, the possibilities are endless. One tantalizing prospect is the addition of "intelligence features" to existing healthcare records. According to Carlson, the extra intelligence could alert providers that a treatment on order is no longer the most effective or that it may cause a particular side effect. An electronic record has the potential to "warn the provider as data is keyed in that there is a problem," he says. "A paper chart cannot."

The result of such accessibility is simple, says Carlson: "Better patient care."

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