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Wednesday, Sep 27, 2023


Los Angeles County’s massive Health Services Department keeps patient medical records the old-fashioned way on paper costing the county millions of dollars in lost staff time and missed billing opportunities, officials say.

With only sporadic computer record-keeping, the county must employ an army of workers to haul hard-copy patient records in and out of storage, said Jonathan Williams, the agency’s director of information services.

The result: an estimated $45 million in losses annually on wasted employee time and federal Medi-Cal reimbursements lost in the shuffle, Williams said, citing a recent county study.

“There is no question that our system needs to be streamlined and revised,” said Williams. “We’re losing time and money so setting up a better computer network has really become a priority for us.”

There are other problems. Doctors report that tests and X-rays have to be repeated under the current system. Also, administrators complain that many times duplicate medical records are created and diagnoses are done over again as patients bounce between hospitals and clinics.

At the same time, the county is increasingly relying on private clinics to treat patients. That means clinics and hospitals scattered throughout the county need the capability to exchange patient records making the need for a new computer system all the more critical.

“Right now there is no clear way to move information around from our hospitals to our clinics to any other health care providers that contract with us,” said Steve Escoboza, the department’s director of managed care. “We’ve gotten behind in the technology of today and there is now a clear focus to at least catch up.”

The county has embarked on a massive program to update and inter-connect its computer system. Health care officials envision a day when patients can be tracked anywhere in the system by a few computer keystrokes.

But this isn’t the first time there have been pledges to fix the problem. In 1990, the county contracted with IBM and Baxter Healthcare Corp. to modernize the department’s computer system.

Instead, the system called IBAX never worked properly. Administrators at the hospitals complained that the system could not keep track of records, and was continually overloading, said Escoboza. By the time county supervisors pulled the plug on IBAX in 1994, it had already cost about $74 million.

Now, the Board of Supervisors has approved a plan that will use new software to update the old IBAX system. The county paid CompuCare Systems Co. of Los Angeles $20 million to link all the county health facilities by 1999.

“There’s a long list of opportunities that this system will give us,” Williams said. “There will be less manpower needed, and we will be investing in the technology that are tools to get things done more effectively.”

He says the new computer system will provide an “infrastructure,” and that the county may spend between $20 million to $30 million more on refinements. Health care officials are currently working on a multi-year budget to outline what must be done over the current improvements, he said.

The new software will run off most of the county’s existing computers and dummy terminals, he said. It will enable hospitals and clinics to keep track of first point of entry for care, registration and assignment of medical records.

Patient scheduling and some medical records will also be stored in the system. In addition, the county will be able to track financial information including how the patient paid, if they had insurance, and if they were using Medi-Cal.

The system will link six hospitals including Los Angeles County/USC Medical Center with six comprehensive health centers and 39 clinics.

“Essentially, most of these facilities have been operating off their own individual systems that were never connected,” Williams said. “The linchpin in all of this is to find a way to mesh these systems.”

The county recently signed a $1 million contract with Software Technologies Corp. to interface the different software systems being used, he said.

Robert Myrtle, a professor of public administration at USC, said the efforts are a good start to fixing a large problem. However, he said much more needs to be done before the system can manage via technology the more than 3 million annual patient visits.

“My guess is that (their effort) is just a spit in the ocean,” said Myrtle, who specializes in health services management. “I could see them spending $20 million to just bring General Hospital up to date, but you are talking about the largest care delivery system in Southern California.”

The problem, he says, is that the county is too cash-strapped to dedicate the resources needed to completely update the system. Myrtle says at least now this is a step in the right direction.

“A lot of places don’t have this kind of technology, but we’re increasingly seeing health care organizations putting up real time information systems to survive,” he said. “L.A. County’s systems are doing what they can with a limited amount of money and any step forward is a positive.”

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