Checkup

Vital Signs

For the Record

Dear Reader:

Dr. William J. Mayo said that the best day's work of his career was the day in 1901 when he hired Dr. Henry Plummer. An organizational genius, Dr. Plummer made many contributions to Mayo Clinic. His most important achievement arguably was the development of the integrated medical record. The idea that a patient's entire medical history should be available in one place at one time was innovative, but in retrospect intuitively obvious. Like many great advances, it makes such perfect sense that it's amazing no one had thought of it before.

Patient No. 1 in the new Plummer system was registered on July 19, 1907; the 1 millionth clinic number was assigned in 1938. The census now exceeds 6 million. What would Dr. Plummer think of the system he set in motion all those years ago? I suspect he'd approve of Mayo's current computer-based records. Paper documents (examination notes, laboratory reports, surgical dictations, copies of correspondence) have been all but eliminated, as information pertinent to the patient's care is recorded and stored electronically. Tests such as chest X-rays, ultrasounds, CT and MRI scans, EKGs, and echocardiograms are available online. This promotes efficiency for a patient's visit through the clinic because the chart doesn't have to "keep up" with the patient. Also, an electronic record allows multiple Mayo specialists access to the chart simultaneously from different locations on campus.

Security, safety, and quality are enhanced, as well. Whereas a patient's paper record in a doctor's office might be perused without detection by just about anyone (all those manila folders on unlocked metal shelves...), an electronic dossier can be viewed only by authorized users who are readily identifiable. Inappropriately accessing a patient's chart is grounds for dismissal from employment at Mayo. With regard to safety, a typed note avoids errors of legibility that might occur with a handwritten entry. Stereotypical jokes about doctors' penmanship exist for good reason, but a mistake in drug dosage is anything but humorous.

We believe that Mayo's integrated medical record has long helped to maintain high standards of quality because the "open book" serves as an excellent means of peer review. It's harder for a single doctor to get too far off the track when others can carefully scrutinize the thinking that led to the diagnosis and treatment plan. The next advances in quality improvement likely will come from the ability of the computer to offer diagnostic possibilities for a certain combination of signs, symptoms, and test results, or to recommend various therapeutic options for a defined problem, such as the best antibiotics for a particular infection. This should save money, too, because the software can identify a less expensive drug that is equally effective.

Despite these advances, a century after Henry Plummer's great idea, the health care records of most Americans are far from integrated. More often, they are scattered among any number of doctors' offices and hospitals. For the record, we will continue to devote considerable resources to improving how we collect, analyze, store, and protect information that is vital to your medical care. We can think of few better investments.

Sincerely,

George B. Bartley, M.D.
Chair, Board of Governors