Reducing Medical Costs by the Book— Electronically
New software technology that overcomes a major obstacle to wide use of electronic medical records is being embraced across the United States, promising to reduce costs and provide a new dataset for analyzing and enhancing medical care. The technology, developed by VitalWorks (formally Datamedic Corp.) of Waltham, Mass., with co-funding from NIST’s Advanced Technology Program (ATP), makes it easy and productive for doctors to enter patient data directly into a computer. A physician can select just a couple of terms in answer to a question and the system produces a grammatical sentence; it also integrates the substance of the entire clinical note into a sophisticated database that can be used for research. A specialized knowledge base was developed to support data collection and text generation. VitalWorks originally focused on gastrointestinal endoscopy; the company also has developed knowledge bases for emergency medicine, internal medicine and family practice, outpatient ophthalmology, renal dialysis, oncology, and rehabilitative medicine. The underlying technology also could have applications in fields such as law and business if appropriate knowledge bases were developed. The advance overcomes a major weakness of traditional handwritten
notes, about half of which fail to note important information. A University
of Iowa study of VitalWorks' gastrointestinal endoscopy system found
that errors of omission fell from an average of 22.8 percent to an
average of 8 percent of notes, and as few as 1 percent of notes in
certain types of cases. Commercial products incorporating the ATP-funded
technology are installed at more than 250 endoscopy sites and 100
primary care and emergency medicine sites involving an estimated 5,000
physicians, according to VitalWorks. The system has been used in clinical
practice for some 30,000 cases over five years at Brigham and Women’s
Hospital’s endoscopy unit in Boston, where the data collected
also have provided the basis for several professional papers. Olympus
America Inc., the leading endoscope manufacturer and a supplier of
medical technology, incorporated the module into a product that supports
gastrointestinal endoscopy. This product is used at several hundred
hospitals and ambulatory care centers, and sales are increasing by
about 25 percent to 50 percent annually, according to Olympus. The
Veterans Administration (VA) selected VitalWorks' system for testing
because it can be embedded into other applications, is sufficiently
structured to generate defensible billing codes, and can support multiple
medical specialties. The VA could save as much as several million
dollars annually in each region by avoiding transcription costs and
the need to hire certified staff for billing coding. May 2000
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