Earlier this year, when President Barack Obama proposed a revival of health care by converting outdated paper-based records into modern electronic systems in five years, hospitals around the country began the shift.

But Norman Regional Health System foresaw the limitations of paper files a year earlier.

While Norman digitized its records years ago, in February 2008, to improve care and cut costs, it installed a comprehensive electronic health record system, allowing providers to look at a patient's medical history over a span of time rather than individual encounters.

"This sets the backbone for physicians to share patients' records with other providers upon request and with the patient's consent," said Dr. Brian Yeaman, director of physician informatics for the hospital, who said the hospital invested its own money in the system before the Obama administration announced a share of the stimulus would go toward offsetting this cost.

And in about a year, the government is expected to help carry the tab.

"This was our plan before the Obama administration came in. Now it's just nice to know we're getting a little relief from the cost," said Yeaman, referring to the $381,000 in stimulus funds the hospital will receive in 2010 or 2011 as part of The Health Information Technology Extension Program.

Currently, the hospital and physicians are pulling money from their own pockets to pay for the switch, Yeaman said.

Not only has Norman's own funds been depleted for the system, which Yeaman couldn't "fairly" pin a price to, saying it's a multi-million dollar project costing $15,000 to $20,000 per provider, there is the hidden cost of lower productivity as personnel adjust to the switch.

"It's not easy. It's expensive. It's time consuming, but I like to think it's worth it because at the end of the day, it saves money. But what we truly hope to see happen is, we provide a safer environment for patient care and more accurate treatment," he said.

While President George W. Bush announced this conversion would be one of his policies during his State of the Union speech in 2004, Yeaman said there was no incentive to the provider or the hospital to shell out the money.

"That's been one of the delays: Who pays?" he said. "It's very expensive and overwhelming, but the stimulus funds will help with that."

He said Norman has 65 providers on electronic health records, and it is currently installing a live hub to transfer information between offices in January.

Norman is also part of a network of 13 metropolitan hospitals for the exchange of patient information.

Switching from paper to digital

While the Obama administration is pushing the most aggressively for the conversion to electronic health records, a Norman entrepreneur has been applying this business model for the last 10 years.

Several years ago, Agi Lurtz, innovator of OnlineMedsource.org, shocked by the inefficiency of the health care system while caring for her father in the late 1990s, joined the weary, disenchanted by the paper trails and long hosptial waits, convinced there was a simpler way.

"I thought if I could make this easier for people, then great," Lurtz said. "If it makes the patient's outcome better, how can it be bad?"

So in 1999, Lurtz created OnlineMedsource.org, which streamlines the process for patients and doctors, allowing patients to complete their health forms at home, securely store those forms and medical information online, find a doctor and research drug interaction.

"We've turned this into a system the people wanted versus what we thought they needed. It's turned into a very organic company," said Lurtz, who used to own a computer store.

The site became Online Medsource Inc. in 2001 and launched its first practice in 2003. In 2006, it expanded into a full-blown electronic health records system.

The site, which allows patients and providers to access the patients' medical information from any computer, is free for patients and costs about $21,000 for two doctors, and physicians should recoup every penny in six months to a year. Others in the market can reach a price point of $500,000.

Yeamna hinted that eventually, the state would like to grow some of these local networks and install an overlay, allowing a network of networks to exchange data across multiple levels of governance and security.

But this is a ways off.

Norman and others are still smoothing the kinks to develop a system capable of transferring patient information by all hospitals, not just a few, and ensuring the information's security so HIPPA regulations are enforced and insurance companies cannot access data to manipulate providers' reimbursements and patients' insurance premiums.

"Ideally, this should be able to happen around a greater distance than one town," he said.

With Norman currently exchanging data with Oklahoma City and the 13-metropolitan hub, some of these boundaries have been broken, he said.

Why the switch

But with all its headaches, the cost benefit of reduced hospital lengths and duplicate testing for the conversion has the ultimate byproduct of saving lives, Yeaman said.

The records system is equipped with the compatibility to test drug-to-drug interactions and drug-to-allergy interactions, meaning the computer can tell if prescribing one drug will interfere with another the patient is taking or an allergy.

And with more than 2,000 medicines floating through his primary care office in varying strengths and doses, Yeaman said this could drastically improve safety by avoiding medical complications and allowing physicians to tune their treatment, preventing future doctor visits and additional testing, and again, more money.

"They might know that they take a blue pill or a white pill. Or they take three pills, but they can't tell you the other two," Yeaman said. "A lot of times, these medicines don't play well together."

These new tech savvy records also minimize hard costs such as paper and file folders, said Lurtz, as she pointed to a stack of the manila sorters on her desk, and reduce redundancy.

With Online Medsource, patients' basic information like their name, address and telephone number self-populates in other forms, minimizing redundancy and saving patients' and hospitals' time, she said.

Plus, electronic records avoid the mind numbing deciphering of doctors' handwriting, said Lurtz, mimicking a doctor quickly scribbling across her desk.

"A lot of errors can happen when people try to read my writing, and when an eight becomes a seven and a four turns into a five," Yeaman said.

What's the problem?

Complicating efforts to make these records more accessible is developing a mechanism for these records to follow patients without compromising security.

In Norman, Yeaman said security levels are fashioned like banks, with firewalls and secure Internet connections.

"That's a touchy area. Your medical history is as sensitive as your bank information, for most people, and we want to make sure we can protect that," Yeaman said.

He said only the patient's physician and physician's nurse have access to these records that can be tracked through audit reports, which leaves a trail of who has viewed the record.

Doctors with Online Medsource can choose which information from their files to include when referring a patient to another doctor.

Yeaman said it is difficult, however, to determine which information to weed out before transferring the information upon a referral to a different type of doctor, especially since many factors play into a diagnosis and can cross the bridge when deciding treatment.

Lurtz brings an outside agency every year to test her system's security by trying to hack in, with no success yet, she said.

Online Medsource also has a voice recognition component.

"So they can save your life, but they can't steal your identity," Lurtz said.