By Joyce Beverly (The Citizen Newspaper)

On Friday, Aug. 8, the U.S.Food and Drug Administration posted a warning concerning the interaction of two well known medications: simvastatin, a cholesterol lowering ingredient in widely-prescribed drugs such as Simcor, Zocor and Vytorin, and, amiodarone, a medication used to control heart rhythm problems. The FDA alert was dosage related, indicating that patients who take more than 20 mg. per day of simvastatin in combination with amiodarone are at a greater risk of developing rhabdomyolysis, a rare muscle injury which can lead to kidney failure or death. Since 2002, 52 cases of serious muscle injury to patients taking this combination have been reported, with most of these patients requiring hospitalization. On Monday, Aug. 11, Dr. Nimish N. Dhruva, cardiologists with Cardiovascular Consultants of Georgia (CCG), received the warning and knew immediately this news may be important to the wellbeing of many patients seen by him and CCG’s eight other cardiologists. That afternoon, he emailed Michelle McElwaney, the practice’s electronic medical records application specialists, asking her to do a search of patients’ electronic data and to notify doctors about which of their patients were taking these two drugs. By noon the following day, a list of more than 100 patients had been generated and their attending physicians notified. By Wednesday, every patient on the list had been contacted by someone on the team at CCG.

Not that long ago, generating that list would have been impossible. Dennis Breslin, chief operating officer of CCG estimates the practice has about 20,000 patients. Nine cardiologists see those patients at four locations, two in Fayetteville, one in Sharpsburg and one in Newnan. Eighteen months ago, all of those patients records were still on paper. Breslin described the logistics involved in making sure patients records would be in the office they visited on any given day as “maddening.” Generating a list like the one described above would have been impossible. Each of those 20,000 records, containing many sheets of paper, would have had to be researched individually. It simply could not be done. Therefore, an FDA warning such as this would have been communicated to physicians through memos or emails, but doctors and nurses could only have checked for those affected as patients came in for other appointments or problems. In April of 2007, however, the practice went digital with GE’s Centricity, an electronic medical record system that allows physicians and staff to document visits, streamline workflow, and securely retain and exchange clinical data with other providers, patients and information systems. Today, Dr. Dhruva and his colleagues can access any of their patient’s medical information from any of their offices, and also from their homes and from emergency rooms and hospitalists can access the records from hospitals. The system interfaces with many lab services, which results in lab results automatically being updated in a patient’s record. And, what may become the most popular aspect of the program, patient portal allows patients to securely access their own records. This feature is expected to roll out in about eight weeks. Through the portal patients can update medication lists, make requests for refills and appointments, direct questions to doctors and nurses, and receive secure replies, view test results and more.

Everyone at CCG understands the value and importance of this new technology, but when one of the patients identified as taking the potentially deadly combination of drugs turned out to be a family member of someone on staff, the message really “hit home.” Breslin said physicians at CCG pushed hard for EMR’s in the practice. The nightmare of paper records was a universal motivator. But “getting there” was no small task or commitment. Software with licenses for nine physicians cost $100,000 or more, but before the system could be implemented many thousands more was invested in a robust, secure network. The man hours spent on this project are inestimable. Delivering high quality cardiovascular care, however, is the ultimate goal of CCG, and the physicians who care for patients treated in this practice are committed to continuing to invest in the electronic medical record system. Dr. Dhruva knows the future of patient care is digital. “If we can go from the cradle to the grave with EMR that would be huge,” he said.