By TOM BREEN

Health care providers across the country are moving to replace their old paper records with sleek new electronic systems, a process the Obama administration wants to speed along with over $17 billion in stimulus dollars.

That’s a tall order for doctors and hospitals, because an estimated 90 percent of health care offices still stack their records in floor-to-ceiling shelves crammed with manila folders.

The administration’s goal is to implement systems that allow doctors and nurses instant access to patient records and to avoid harmful errors in prescriptions and medical charts. But some worry the software isn’t yet ready to replace the ease of use of paper records, and say the cost of the systems may be too steep.

Dr. Theodore Hole, a family physician in Ventura, Calif., said when he sees patients who have electronic records from other physicians, they’re often a collection of checked boxes and fill-in blanks that are meaningless to doctors outside of the group using the system.

Health care providers such as doctors and hospitals would be reimbursed by higher Medicare and Medicaid payments if they put the systems in place by 2011. Doctors can receive up to $60,000 and hospitals up to $11 million. If they don’t switch, they could see their Medicare and Medicaid dollars decline.

The health care industry has been moving toward electronic records for years, but the rate of adoption has been slow. Some providers are intimidated by startup costs, which can range anywhere from tens of thousands of dollars for a doctor’s office to $100 million for a large hospital.

“It’s not going to be enough to pay for it; it’s going to be enough to make you want to engage with it,” Sentara Healthcare Chief Information Officer Bert Reese said of the stimulus incentives.

The southeastern Virginia network of seven hospitals and hundreds of doctors is in the midst of a decade-long, $237 million conversion project, with all hospitals scheduled to be on board next year. The stimulus plan could mean as much as $40 million to the network, he said.

Though the systems vary, advocates say computerized records are safer and more efficient. There are fewer mistakes that come from trying to read handwriting, and anyone in a medical system can access the information. When a patient comes into the hospital complaining of chest pains, for example, emergency room staffers don’t have to hunt down past medical records for allergies, medications and other information because it’s immediately available on a computer screen.

The idea is also to shorten the time involved in basic procedures. Under a paper system, Sentara’s Reese said, a doctor entering a medication order for a hospital patient can expect to wait up to an hour before the first dose is administered. With electronic records zapping the order directly from the doctor to the hospital pharmacy, Reese said, it can take about five minutes.

The Obama administration believes converting to electronic medical records will improve patient safety and overall health as well as bring down costs across the spectrum from public to private care, according to the DHHS.

“It’s an excellent use of the stimulus money,” said Dr. Margaret Staggers, a Fayetteville physician who, as a member of West Virginia’s House of Delegates, will help determine how the plan shapes the state budget. All seven of West Virginia’s state-owned hospitals have the system in place. “Doctors are interested in getting these systems, but there’s so much upfront cost.”

Trinitas Hospital in Elizabeth, N.J., estimates it can get $11 million in stimulus funds for its $30 million electronic health records system, according to Ken Raske, president of the Greater New York Hospital Association, which represents about 300 hospitals in the Northeast.

“It’s not a bad down payment, but it gives you an idea of the proportion that comes from the stimulus package as opposed to the money they need to invest,” he said.

Still, conversion could be slow. An April article in The New England Journal of Medicine concluded there are no reliable estimates on how many hospitals have electronic records, mainly because providers have implemented systems with a piecemeal approach. But it estimates roughly 7.6 percent have at least a “basic” system. For physician practices, the figure is probably around 4 percent.

There are also questions about ease of use, maintenance, compatibility with other systems and keeping all that data secure. Perhaps most urgently, no one yet knows what systems will qualify for reimbursements and keep providers from seeing reduced Medicare and Medicaid payments.

Because of the uncertainty, it’s too soon to tell whether the stimulus plan is getting more providers to make the switch, said John Morrissey, spokesman for the Certification Commission for Healthcare Information Technology.

“With so many unanswered questions, it’s kind of ludicrous to go too far into it,” said Joe Letnaunchyn, president of the West Virginia Hospital Association. “You run the risk of spending money inappropriately.”

Above article published on http://www.businessweek.com/ap/financialnews/D9810JVG0.htm

HITECH Act entices physicians into future with incentives

By Jill Coley

The federal government has put aside nearly $20 billion to convince doctors to ditch their manila files for electronic medical records. But look at any physician’s walls of patient records, and the enormousness of that task becomes apparent.

In the Lowcountry, opinions are mixed. Most agree the move would reduce unnecessary testing, administrative overhead and medical errors. Yet with so many systems to choose from, patient privacy concerns and the time it takes to learn new software, money might not be enough.

Dr. Christos Maltezos, a Mount Pleasant endodontist, is ahead of the curve and already paperless. “That’s where the future is going,” he said. Patients can fill out forms at home and enter their medical and pain histories online.

In addition to streamlining administrative work, going digital also reduces forgery since doctors can send prescriptions to pharmacies digitally, said Maltezos, who can access patients’ records on his BlackBerry no matter where he is. “I don’t think I could do it any other way now,” he said.

Starting out digital is easier than changing over. The older internist may imagine scanning in 300-page medical records. But after a few patient visits, most of the information would be contained in an electronic file.

The Health Information Technology for Economic and Clinical Health Act, or HITECH, became federal law in February and created payment incentives in Medicare and Medicaid to encourage providers to go digital. It wasn’t long before electronic medical record vendors began using the promise of stimulus money to entice physicians.

Chris Hughes, founder of Advanced TeleHealth in Mount Pleasant, consults physicians before they adopt an electronic medical records system to make sure their practice is ready for the technological leap and is compliant with the Health Insurance Portability and Accountability Act, or HIPAA.

The economics of the situation is going to drive electronic medical records forward, Hughes said.

Dr. Dave Albenberg is passionate about electronic medical records but worries the government’s lofty goal may not be feasible.

Albenberg invested about $150,000 in a digital system for his concierge practice, Access Healthcare, in Charleston and Mount Pleasant.

Every doctor thinks it needs to be done differently, and getting all of them on the same platform is impossible, Albenberg said. “This is something you can’t throw money at,” he said.

Dave Terry, former administrator of James Island Medical Care, knows firsthand the pitfalls of electronic medical records. The 6,000-patient practice tried to go electronic about six years ago, and although hardware and software has improved since, the experience is still fresh in his mind.

Doctors use so many categories of codes, Terry said, that when physicians got in a room with a patient, the program went “six ways to Sunday.”

“You feel quite often like a deer in headlights in the middle of a patient encounter,” he said. Training was a problem because doctors couldn’t stop seeing patients long enough to learn the system. And if a staff member was sick or on vacation, their replacement had to be schooled in the software.

“We yanked it out and went back to paper,” Terry said.

Above article published on http://www.postandcourier.com/news/2009/may/04/doctors_look_into_digital_age80979/