By Alec Rosenberg

A digital revolution is sweeping across University of California medical centers, as they switch to electronic health records. The new systems will help deliver care that is better, safer and smarter. Doctors will have instant access to lab tests. Patients will know they are getting the right medication. Providers will extend care coordination throughout the community.

The technology is not just a competitive edge; it's part of a national imperative to transform health care.

Electronic health records are a key piece of federal health reform and a strategic priority for UC Health. All five UC medical centers are moving toward qualifying for federal incentives, which the government is offering those who go digital in a way that improves patient care and safety. Indeed, UC San Diego and UC Davis are considered among the top 3 percent of hospitals in adopting electronic health records, while UC Irvine is close behind and UCLA and UC San Francisco are busy implementing their systems.

Health reform and UC: Regents to receive update What's the impact of health reform on the University of California? UC Regents will receive an update at their March 17 meeting at UCSF Mission Bay Community Center, 1675 Owens St., San Francisco. View the agenda item. Listen live — the estimated start time is 10:15 a.m.

"UC has world-class medical centers," said Dr. John Stobo, UC senior vice president for health sciences and services. "We're already beginning to see the benefits of electronic health records. Adopting electronic health records systemwide will help UC meet the goals of federal health reform, to increase quality, improve patient care, enhance collaborations and drive innovation."

The transformation is complex, involving lots of coordination and training, not to mention financial commitment. UC's medical center chief information officers have spearheaded the effort, collaborating to share best practices and learn lessons from each other.

At UC San Diego Health System, patients can go online to a secure site, look up their clinical information, make an appointment and request a prescription refill. Doctors can get instant access to CT scans, eliminating wait times, increasing efficiency and improving outcomes. The emergency department uses an Internet-based referral system to schedule follow-up appointments at community clinics, improving patient care while reducing return ER visits.

UC San Diego began work to automate clinical information about 10 years ago.

Ed Babakanian, CIO, UC San Diego Health System

"The notion has always been to leverage technology to improve quality of care, patient safety and efficiency," UC San Diego Health System CIO Ed Babakanian said. "Now they are a national focus."

For UC San Diego hospital patients, all medications are bar-coded. A scanner checks to see that the bar code matches the identification on a patient's wristband before medication is administered.

"You get the right medication to the right patient," Babakanian said. "It improves safety because it eliminates potential errors and it reduces costs because the order goes directly to the pharmacist."

UC San Diego Health System has been named one of the nation's "Most Wired" for five straight years and, for the fourth time, one of the "Most Wireless" by the American Hospital Association. Its advanced status helped it receive a $15 million federal Beacon grant that will use information technology to enhance coordination among San Diego hospitals and clinics and improve community health.

UC San Diego expects to qualify to receive federal incentive funds for electronic health records and will apply for them, Babakanian said.

The American Recovery and Reinvestment Act of 2009 provides $19.2 billion in Medicare and Medicaid health information technology incentives over five years. Beginning this year, Medicare and Medicaid will provide financial incentives over multiple years of up to $11 million per hospital and $63,750 per eligible physician for "meaningful" use of health IT, such as improving quality, safety, care coordination and public health. Beginning in 2015, hospitals and physicians face financial penalties for not meeting meaningful use guidelines.

"It's the right thing to do," Babakanian said. "Those who hadn't, now they have an incentive to do so."

The value of being digital

Michael Minear, CIO, UC Davis Health System

Electronic health records are a hot topic in health care. In February, a record 31,225 people attended the annual conference of the Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization whose analytics arm assesses hospitals' adoptions of electronic health records. UC Davis was honored for achieving the organization's second-highest designation for electronic health record systems, joining an elite group of 3 percent of U.S. hospitals that includes UC San Diego.

"Our clinical data is now fully digital," UC Davis Health System CIO Michael Minear said. "Now we don't use paper or film, have EHR software that really works, and we are exchanging patient data with other clinicians in our community."

UC Davis began deploying its electronic health records in 2002 and had all types of clinical encounters (inpatient, ambulatory, emergency department and home care) fully supported by the EHR by late 2009.

Since December, UC Davis has been able to share electronic health records with Sutter Health, as both organizations use the same platform. In the first 13 weeks of use, the two health providers shared 924 patient records.

UC Davis plans to share electronic health records with additional providers, including Catholic Healthcare West. Also, more than 1,700 community physicians can access their patients' records and digital images in the UC Davis system. In addition, more than 32,000 UC Davis patients are using the Web-based MyChart (a tethered personal health record), where they can access their clinical information and send and receive secure messages with their physician and care teams.

"I believe our modern technology is helping clinicians every day, but I think the real winners are the patients," Minear said. "If you're treating an emergency patient, having access to the patient's clinical history can save time and the cost of extra tests, but at other times it may literally be the difference between life and death."

UC Davis, which expects to start qualifying this year for federal EHR incentives, continues to add advanced applications. By later this year, all its hospital patients will receive bar-coded medication administration.

"Our physicians, nurses, pharmacists and therapists have been amazing partners in deploying modern clinical software," Minear said. "Our success is based on teamwork and ensuring clinical goals and requirements drive our use of technology."

A better system

Jim Murry, CIO, UC Irvine Healthcare

UC Irvine is in the middle of its EHR implementation. Its first phase went live in September 2009 and second phase in October 2010, which mostly focused on the hospital. Now doctors can enter orders online such as tests, drugs and medications. Electronic medication management helps ensure that patients take the right medications at the right doses.

"If our clinicians can get to a computer, they can get access to a chart," UC Irvine Healthcare CIO Jim Murry said. "They have information at their fingertips they might not have ever had. They're going to have access to every image, every X-ray, every report."

Since October, Murry has received more than 250 requests for enhancements. "Our clinicians are beginning to see the power in such technology," he said.

The third phase, scheduled to go live by year end, will focus on the clinics' mobile devices — allowing UC Irvine doctors to check results on an iPhone and connecting with community outreach tools such as patient and community physician portals and health information exchanges. The fourth phase, targeted for summer 2012, will integrate medical devices and extend electronic clinical documentation. UC Irvine is positioned for federal EHR incentives, which it plans to seek next year, Murry said.

"I'm very happy with our roadmap," Murry said. "It's going to make us a better system."

Implementing electronic health records is UC Irvine Medical Center's top strategic initiative, Murry said. It will help improve quality and service and keep the university competitive in the marketplace, he said. It also will enhance collaboration: UC Irvine is working with other Orange County providers to connect their EHRs, starting with a pilot project this summer involving emergency room patients.

Safety is guiding force

Larry Lotenero, CIO, UCSF Medical Center

UCSF Medical Center is on a fast track to implement its new EHR system, which it calls APEX (Advancing Patient-centered Excellence). In April, APEX will roll out to the first of four waves of ambulatory clinics. The hospital rollout is scheduled in October. UCSF expects to deploy the full system by spring 2012. It eventually will extend to its Mission Bay hospital complex, slated to open in 2014.

"It's going really well given the size of the task," said UCSF Medical Center CIO Larry Lotenero. "We are moving as fast as we safely can, but safety is really the guiding force. Patient safety is paramount."

By summer, UCSF patients will be able to schedule appointments electronically, Lotenero said. Also, UCSF will install kiosks so patients can check in for appointments, similar to ones that let passengers check in for a flight at the airport.

By October, UCSF will add bar-coded medication administration, which will complement its new automated hospital pharmacy that uses robotic technology and electronics to prepare and track medications — not a single error has occurred in the 350,000 doses of medication prepared during the system's recent phase-in. "This will really help our care providers a lot," Lotenero said.

What UCSF is doing is in line with what President Barack Obama is trying to do with health care reform, such as increasing collaboration and transparency, Lotenero said. For example, UCSF plans to share its electronic health records with organizations such as Kaiser Permanente, Sutter Health, Stanford, Catholic Healthcare West and Hill Physicians Medical Group. Lotenero also sees potential for UC medical centers to collaborate in areas such as best practices for physician order sets, patient care plans and warehousing data.

Building collaborations

Virginia McFerran, CIO, UCLA Health System

Collaborations across the system already are paying off. UCSF's advice is helping UCLA reduce its EHR implementation time by up to six months, said UCLA Health System CIO Virginia McFerran. Furthermore, the CIOs at the five UC medical centers regularly discuss ways in which patients, researchers and students can benefit from easier information exchange across the system as well as opportunities to reduce costs.

UCLA signed its EHR vendor contract in November and is expected to begin deployment in 2012.

Federal incentives played a part in catalyzing UCLA's decision to choose an integrated system. "The incentives were one of several reasons UCLA determined the time was right to implement an electronic health record solution," McFerran said.

UCLA calls its program CareConnect and its first guiding principle is to make implementation decisions based upon the best interests of the patients. In addition to enabling increased quality of care, CareConnect will ultimately provide patients with conveniences including a Web portal to schedule appointments, online access to test results and communication options with their providers.

"I'm excited. This will be transformative for our organization and tremendously beneficial to our patients," McFerran said. "It's going to provide a better experience and better quality of care for our patients."

Alec Rosenberg is the health communications coordinator in the UC Office of the President's Integrated Communications group. For more news, visit the UC Newsroom or follow us on Twitter.