Health IT wasn’t quite in the dark ages in 2003 – but it sure was close.

“I was talking recently with a man who told me about visiting an endocrinologist 10 years ago,” said Cheryl Stephens, CEO of Community Health Information Collaborative, based in Duluth, Minn. “The doctor kept a little spiral-bound notebook in his top pocket that had a page for every patient, with tiny notes about whether this hormone had gone up or down, etc.

“And the guy asked the doctor, ‘What would happen if you lost that book?’ And the doctor said, ‘Well, I give that book to my nurse every night and she takes it and copies it onto a piece of paper and enters it into the patient’s record.’”

Which said something about technology’s place in healthcare back when Healthcare IT News launched.

“In 2003, fewer than 5 percent of hospitals in the U.S. had any form of electronic records,” said David Brailer, MD, who became the nation’s first ‘heath information czar” in 2004. “A smaller percentage of doctors’ offices had them, probably less than 1 percent.”

Brailer was appointed national coordinator for health information technology under an executive order by President George W. Bush, as part of a 10-year goal to modernize health technology. Though he spent just two years on the job before becoming CEO of private equity firm Health Evolution Partners, Brailer helped kick-start bipartisan efforts, in Washington and on the state level, to build an interoperable, standards-based Nationwide Health Information Network.

[See also: Healthcare IT leaders hail Brailer choice as IT chief.]

“It was something everyone knew was inevitable, but the fire had not been lit,” he tells Healthcare IT News. “People were frustrated with paper records. Patients were frustrated not having their information. People who wanted to do health reform wanted to find ways to make a difference, but couldn’t. More than anything, the efforts to bring cost efficiencies to the industry simply couldn’t be done without it. So it was an idea whose time had come.”

Nine years later, Brailer said, “About 85 percent of hospitals now have electronic records in place or almost in place, and about 60 percent of doctors’ offices have them.”

While much more progress clearly needs to be made to modernize the use of information technology in the U.S. healthcare system, Brailer said, “It’s breath-taking to me to see it happen. It’s much grander, it’s much more significant, much more sweeping and global than what we ever thought it would be.”

Getting online
By 2003, computers long had been a presence inside major medical facilities and healthcare organizations, used primarily for basic patient data entry. In clinics and doctors’ offices, healthcare providers might haul a cumbersome laptop from one room to another as they make rounds to see patients.

But the primary “technology” for patient data storage remained paper, in large part for cultural reasons.

“If a physician had to sign off on a discharge summary, it had to be printed for them because most weren’t going to sit down in front of a computer and read it,” said Stephens.

And even if a health organization cobbled together its own system of electronic records, those records typically couldn’t be accessed from outside the network. Further, there were gaps and inefficiencies in how EHRs were kept and shared.

In recent years, the federal push to modernize healthcare systems has prompted many large health organizations to dump their older, home-brewed electronic records – even pioneering, respected systems – for platforms built by vendors specializing in healthcare systems.

Boston-based Partners Healthcare, the largest healthcare provider in Massachusetts, for years has relied on systems dating in large part back to the 1980s at Massachusetts General Hospital and Brigham and Women’s Hospital, two of the preeminent academic medical facilities in the country.

Faced with the task of integrating and updating records from three dozen hospitals and community health centers and more than 6,000 doctors in the Bay State, Partners last year signed a $600 million contract with Epic Systems Corp. of Verona, Wisc., to roll out a single system over a 10-year period that would allow access by all Partners care providers to a patient’s up-to-date electronic health records.

And just three months ago, Intermountain – which provides healthcare through more than 1,000 medical professionals at hospitals and clinics throughout Utah – announced it will replace its existing homegrown system with one built by Cerner Corp. of Kansas City, Mo.

Marc Probst, vice president and chief information officer for Intermountain Healthcare, said the nonprofit provider opted for Cerner because its platform is based on open architecture.

[See also: Intermountain signs sweeping EHR deal.]