Editor's Note: Founded in 1919, this year marks the 100th anniversary for South County Health. As part of our community outreach efforts, The Independent has partnered with the organization on a series of stories related to the history and mission of South County Health. They will run periodically in our newspapers this year and will appear online on our website at IndependentRI.com.
WAKEFIELD, R.I. — In 1962, South County Hospital’s clinical laboratory was processing 14,125 procedures annually. Within 15 years, that number had shot up to 275,345 a year – an astonishing increase in 15 years.
Yet, when Maureen Klaboe was hired as a lab tech two years later, in 1979, all the orders and results still had to be entered manually.
“When I first started, we didn’t have a computer system,” she recalled. “So we used to write down all the values from the machines – glucose 100, BUN 12, etc., and we’d transcribe them onto a multi-part form that had all the reference ranges on it. The original copy would go to the doctor and then we’d keep a file in the lab. We’d use the back copy to go to the billing office.”
In November 1979 the hospital would open a new clinical lab as part of a two-phase expansion that also added X-ray space and replaced the old Emergency Room. The technology also began to evolve.
The lab’s equipment in 1979 included a flame photometer, which measured sodium potassium through the color spectrum of a real, tiny flame. “It was pretty primitive,” Klaboe said.
Back then, there were no universal protocols on protective garb in medical settings. Such standards were not adopted until the mid-1980s.
“People would smoke in the lab,” Klaboe recalled. “You’d have your coffee next to a tube of blood specimen. We didn’t wear gloves.”
Lab workers also practiced mouth pipetting to transfer liquids, in much the same way you would siphon gas from a car tank.
“That was a really archaic practice,” she said. “You’d be sucking up blood to transfer it in a certain amount from one container to another.”
It was the fear of contracting hepatitis, not AIDS, that changed the protocols at South County Hospital. Smoking and drinking beverages were banned in the lab and workers began to wear gloves.
Today the clinical lab is fully accredited and conforms to all OSHA and industry standards.
EMR changes everything
Perhaps no computer innovation changed the practice of medicine more in recent years than the Electronic Medical Record. Love it or hate it, doctors say the change from paper charts to electronic ones has transformed recordkeeping for good.
When the Telecommunications Act of 1996 was signed into law, it created a committee to study electronic medical records and offered incentives for hospitals and physicians to adopt them. EMRs, as they are called, did not become mandatory until 2014.
The advantages over paper charts quickly became obvious. Dr. Neil Brandon, of South County Cardiology, recalled the old days.
“I used to get a call at night from the ER about a patient, he’s got chest pains … he’s Dr. [Steven] Fera’s patient, so I know nothing about this patient,” he said. “I’ve got to get in the car, drive initially to that Narragansett office, go grab a paper chart, bring the paper chart over to the emergency room, go through the chart … It was a joke.”
Now, the record comes into his phone immediately. “I know exactly what’s going on. I can look at their echo[cardiogram] on another app. There’s so much information that I have.”
One early adopter of EMR was South County Internal Medicine in Wakefield, which began using Allscripts in 1997.
“The concept was that the medical records would be more complete, they would be legible, interoperable or shareable within the office, to start with,” said Dr. N.S. Damle. “Everybody in our office can access the record for whatever purpose they need.”
But the government did not require the private companies’ systems to be interoperable. Doctors may have an interface to access imaging in the hospital’s system, Meditech, but Allscripts, for example, cannot talk to Epic, another popular program. Each state Health Department in turn has its own system, making transfer of records between states challenging.
The situation sometimes reaches the absurd.
“I log into five EMRs a day to get the information I need,” said Brandon.
When Dr. John F. Murphy returned to South County Hospital recently after working at Kent, he brought a number of patients with him. The only problem was transferring their records from Epic, the EMR program used at Kent, to Greenway, which South County Cardiology uses.
In the first months of 2019, Murphy had two monitors on his desk – one for Epic, one for Greenway.
Klaboe was recruited from the lab to the IT department in 2011 when the hospital acquired the Greenway system for its medical practice groups. One of her jobs is to make sure the physicians can access the interface of the hospital’s system, Meditech.
“The hospital uses one system and the medical group uses another,” she explained, adding that it would cost $12 million to integrate the hospital system with the medical group system.
Expense is a downside to the electronic medical record. Damle estimated it can cost $30,000 to $40,000 per year per physician to keep the systems updated.
Dr. Joseph O’Neill, a retired obstetrician and former vice president of South County Hospital, is one of the skeptics.
The EMR was supposed to drive down costs and improve outcomes, but Medicare found “the cost was higher by a lot and the value was the same in terms of the patient,” O’Neill said.
He said it’s harder to follow the narrative of a patient’s history with the computer programs, which have a lot of boxes to be filled in but not a cohesive story of symptoms, diagnosis and treatment.
While supportive of EMR, Damle agreed that can be a problem. “What you get is a series of notes that are duplicates of each other because there’s been much copying and pasting of the same information, so you lose that narrative,” Damle said.
Still, the EMR’s advantages – particularly in being able to view and share test results and patient histories – have far outweighed the disadvantages.
“I see the EMRs as more positive than negative,” Brandon said. “It takes a lot of work and effort to master it … It is a skill. You have to balance having your nose in the computer versus paying attention to the patient.”