Lack of record access drives up costs at L.A. hospitals for poor

Lack of record access drives up costs at L.A. hospitals for poor
L.A.'s safety-net hospitals are scrambling to match others nationally that use electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.
By Noam N. Levey
Los Angeles Times
November 25, 2011

The emergency room at White Memorial Medical Center on Los Angeles' Eastside was buzzing when paramedics arrived on a Friday night with an elderly man slurring his words and complaining of aching bones.

The nurse in the receiving bay immediately ran through standard triage questions: "Are you diabetic? Do you have high blood pressure? Are you allergic to any medications?" Each drew the same response: "I don't know."

The hospital and doctors had no record of the man or his medical history. And with their only guide a piece of crumpled paper they found tucked into the man's pants that seemed to indicate he might have had cancer, doctors had to order a full diagnostic work-up, including blood tests and an EKG to check his heart.

It was another night of high-priced detective work at one of America's urban hospitals.

"We're mostly flying blind here," said Dr. Brian Johnston, the senior emergency room physician at White Memorial, shaking his head at the high costs generated by the lack of records and unnecessary testing.

Waste bedevils much of America's fragmented healthcare system, driving up already skyrocketing costs. As health spending overwhelms government budgets, the stakes are especially high for safety-net institutions like White Memorial that serve the country's poorest patients, largely at taxpayer expense.

The best safety-net systems — in Denver, Dallas, New York and elsewhere — have found ways to practice medicine more efficiently, using electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.

In Los Angeles, Chicago and many other cities, local healthcare officials are now scrambling to catch up.

"There is really no system of care here," said Allen Miller, a Los Angeles consultant who is working with private hospitals, clinics and physicians on a potentially trailblazing initiative to link together medical providers that care for some of Los Angeles County's neediest patients...