Carousels that used to hold paper medical charts sit empty in nurses' stations at Kaiser Permanente Medical Center in Fresno.
At Children's Hospital Central California in Madera County, doctors grab a computer -- not a pad -- to write prescriptions.
And in the emergency department at Kaweah Delta Hospital in Visalia, laboratory results pop up on computer screens.
It's all part of a sweeping move toward electronic medical records at hospitals and medical offices across the country.
There are many reasons to make the switch: Electronic medical records improve efficiency and reduce medical errors, health experts say. Doctors and nurses don't have to run around the hospital searching for charts. Nurses don't struggle to decipher scrawled doctors' orders. And computers flag doctors when they prescribe a drug that could cause an allergic reaction or dangerous interaction.
But there are obstacles. Building an electronic-records system can be expensive. A doctor in solo practice can spend $150,000. Big hospitals can spend millions.
Yet hospitals in the central San Joaquin Valley are moving to electronic medical records as fast as they can, hoping to cash in on millions of dollars in federal stimulus money available to help them join the electronic age.
Adding to the urgency: Medical providers face penalties if they don't make the electronic transition by 2015. They could see reduced Medicare and Medicaid payments from the federal government.
It's inevitable that paper patient charts will disappear, health experts say.
"At some point, everyone will have some form of electronic medical record," said Sean McFarland, a nurse at the veterans hospital who has a master's degree in nursing informatics, an emerging field of health information technology.
The paper barrier
Still, there is a long way to go before the last paper chart.
According to one recent survey, only 1.5% of 3,049 hospitals have a comprehensive electronic-records system.
And only an additional 7.6% had a basic system, meaning electronic records in at least one clinical unit, according to the nationwide survey given from March to September 2008 to hospitals that belong to the American Hospital Association.
The researchers -- who reported their findings in The New England Journal of Medicine -- said a policy focusing on financial support and training would be necessary to spur hospitals to adopt electronic-records systems.
Money to buy systems was the most common barrier cited by the hospitals. Seventy-four percent expressed that concern.
Valley hospitals have come face-to-face with the costs.
Madera Community Hospital, for example, has purchased software and expects to have electronic medical records in place within the next two years, said Mark Foote, vice president of finance. But the hospital will spend $2.5 million to $3 million for it. Other than a new building, "it's probably one of the single largest purchases" for the hospital, he said.
Foote questions the government's plan to help.
"The way the stimulus bill is written, it's a carrot with a stick," he said. Hospitals must build a system before they can apply for stimulus money, Foote said. And they can be punished if the system doesn't meet government standards.
For Community Medical Centers in Fresno, the cost is about $75 million over seven years to build an electronic-records system for Community Regional Medical Center, Clovis Community and Fresno Heart and Surgical Hospital. Community is two years into the process, said George Vasquez, chief technology officer.