By Rosemarie Nelson

The economic stimulus bill (the American Recovery and Reinvestment Act of 2009, or ARRA) provides incentive payments up to a maximum of $44,000 per physician over five years for “meaningfully using health information technology.”

Although we don’t yet have definition of “meaningful use,” we can be pretty sure doctors will need to be e-prescribing, exchanging information electronically, and reporting clinical quality measures.

Rather than wait for that definition, start your EMR selection and implementation project now. And start it with an educational demo.

An educational demo is an opportunity for a vendor to help you understand what his EMR can do for your practice, so that as you evaluate products and services, you’ll have a better understanding of how to get a good fit.

The demo serves as an introduction to the possibilities that an EMR brings to a practice for improved operational workflow. That workflow includes both the patient flow when the patient visits the practice and the paper flow that occurs in anticipation of a visit or as the result of a visit (follow-up test results, telephone calls, correspondence, etc.).

Technology changes what is feasible and the demo will help open up ideas that you might not be able to anticipate without some background about the potential.

Pay attention to all the “set-up” and “follow-up” work the EMR can help with “around” the patient visit. In other words, do not get too hung up on the use of the EMR inside the exam room.

The chart is handled and touched and prepped and moved about three times as much outside the exam room as it is inside the exam room. This is especially important for the physicians viewing the demo to remember, because there will be a tendency to think about how it effects the doctor in the room with the patient.

You need to look at the breadth of the interaction with that chart around its entire use.

Look at two aspects of how the prescription function works. One being the first time you prescribe a medication and the second being how the reissue of a prescription will work, including the “messaging” between the nurse on the phone and the provider approving the reissue.

Also look at the messaging and communication systems in general — how will the ability to report and communicate in-office lab test results improve the workflow?

Get comfortable with the “home” page or your “desktop” (all vendors call it something different) where you will “run” your day. Look at the incoming messages and how they are highlighted or categorized.

Look at your schedule for the day with patient information, and how that is integrated/passed from the practice management system.

Get a sense of how you can navigate from a message to the patient’s last office visit documentation and then how you can generate an order (in house or outside the practice).

Know where you’ll find information about the patient’s insurer so you know which ancillary services can be provided by which testing centers, etc.

Try to learn, too, about how external documents will flow through the system — where is the point of entry in the practice and then how does the document get into the patient’s record and to the correct person for review?

Keep the 80-20 rule in mind. In other words, you will have instances that pop into mind about that one-off or atypical encounter and you’ll get caught up in the demo about how to accommodate that. Stop and ask yourself, how often is that an issue? Chances are it’s not worth spending time in the EMR demo on such problems. No EMR can accommodate every situation.

These may seem like a lot of things to consider in a 90-minute demo, but they can all be covered.

And be sure to ask questions, especially if things are not obvious or demonstrated for you.

But above all, get started! There’s economic stimulus money to be had.

Above article published on

http://www.medpagetoday.com/Columns/14250

Scott N. Wolfe

A major focus of the American Recovery and Reinvestment Act (Stimulus Act) that President Obama signed in February is to improve the quality and expand the scope of health information technology in the United States. One of the central goals is to develop a nationwide health IT infrastructure and transfer all Americans’ health records to electronic format by the year 2014.

Under the Stimulus Act, the Office of the National Coordinator for Health Information Technology (ONCHIT) received a $2 billion appropriation to achieve these goals. The funds will remain available until expended; however, the law requires that certain portions of the funds must be allocated to specified groups. ONCHIT will be advised by two policy committees comprised of members from the various sectors of the health-care industry. ONCHIT is charged with a number of oversight activities, including the development of uniform health IT standards to allow interoperability among diverse health IT systems. “Making the electronic health records dream a reality will depend upon the successful development of uniform HIT standards,” said Andrew Gantt, a partner in the Health Care and Life Sciences Group at the Washington D.C. office of Latham & Watkins. “This is critical to ensuring that multiple electronic health records technologies are able to communicate effectively with each other.”

One of the named recipients under the Stimulus Act is the National Institute of Standards and Technology (NIST). NIST will receive $20 million of the budget allocation to continue advancing the use of health IT. The law also earmarks $300 million to support sub-national and regional efforts in their advancement toward health information exchange.

The Stimulus Act also contains various financial incentives to specified groups who adopt and increase their use of electronic health records and health IT. Medicare providers, for example, are entitled to receive up to $44,000 ($48,400 for providers in a professional shortage area) of funding if they adopt and engage in a “meaningful use” of certified electronic health records technology. The standards that providers must meet to satisfy the “meaningful use” requirement in order to receive incentive payments include, among other things, the ability to connect in a way that provides for the electronic exchange of health information and a willingness to report information on clinical quality measures to the Department of Health and Human Services.

The law also incentivizes Medicare providers by penalizing them if they do not become electronic health users by 2015 through a one to five percent reduction in payment the providers would otherwise receive. Similar financial incentives, which can total $63,750, are available for Medicaid providers who implement electronic health records technology. Providers eligible for both Medicare and Medicaid incentives may only receive incentives from one or the other.

Hospitals are also entitled to receive funding under the Stimulus Act if they can demonstrate that they are “meaningful users” of electronic health records technology. A formula determines the amount that hospitals can receive, with the amount starting at $2 million. Grants will also be available to universities that develop centers designed to generate innovative approaches to the use of health IT.

State or state-designated entities are also eligible to receive grants if they submit a plan describing activities to be carried out to facilitate the exchange of health IT. In addition, regional centers that assist in the promotion and advancement of health IT may receive grants for the continued development of technological approaches. To secure their grants, however, these groups must contribute matching funds up to a certain percentage of the federal funds they intend to receive.

Universities and clinical health education programs that expand educational programs focusing on medical information are eligible to receive grants, if they contribute matching funds of at least 50 percent of the cost of the program. In addition, the Stimulus Act authorizes the establishment of loan programs, administered by states and Indian tribes, to health care providers who facilitate the adoption of certified electronic health records technology. Like many other incentives, however, the entity receiving the grant must match the federal funds received with a percentage of the amount received.

Advancing and expanding the use of electronic health records across the United States is a top priority under the Stimulus Act. With financial incentives being provided to various groups to facilitate the shift to electronic records, and a renewed drive to develop uniform health IT standards, the goal of having all Americans’ health records in electronic format is more likely to be attained.

Scott N. Wolfe is the Chair of the Corporate Department and partner-in-charge of the San Diego North County office of Latham & Watkins LLP

Above article published on

http://www.xconomy.com/san-diego/2009/05/08/
a-brief-guide-to-stimulus-act-funding-for-health-information-technologies/

By now you’ve heard about the $850 billion American Recovery and Reinvestment act of 2009 - the stimulus bill recently passed by Congress. The bill is aimed at spurring economic growth across multiple industries by way of government spending.

What’s in it for you?

Well if you are a healthcare provider, you can take advantage of the $51 billion that has been allocated to the health care industry, $19 billion of which will be used to incentivize medical practices to adopt and implement Electronic Health Records (EHRs), also known as Electronic Medical Records (EMRs).

How does the subsidy work?
Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 - $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums.

For the first year a physician is deemed to be a meaningful user, he or she will be eligible for payments of 75% of that year’s Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. The incentive payments decline for each subsequent year within the five year period; $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.

No incentive payments will be available after 2015, and no payments will be offered to physicians who first become eligible after 2014. This creates a decreasing incentive for late adopters.

What is a “meaningful user”?
To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” The bill defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a “qualified EHR”; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria.

HSS will be working throughout 2009 to set the necessary criteria for certifying systems, and is expected to have a final report by January of 2010. Many expect CCHIT certification to play a major role in setting standards of interoperability. (See “Should CCHIT Influence Your EHR Selection” for more information). After all, HHS funded the creation of CCHIT to start certifying EHRs a few years ago.

How do I qualify for the maximum payment?
In order to receive the maximum payment, physicians must qualify as a meaningful user in 2011. Eligible physicians will receive a first year bonus of $18,000 (up from $15,000) and will max out the payment schedule over the next five years.

The table below illustrates the amount of a subsidy paid each year (columns) based on the year the provider first becomes eligible (rows):

No payments will be offered to physicians who first become eligible after 2014.

Practices with multiple physicians will be eligible to receive incentive payments for each provider. Remember that payments will be based on 75% of the correlating year’s Medicare and Medicaid charges. Therefore, in order to qualify for the maximum payment of $18,000 in the first year, each provider must bill Medicare or Medicaid a minimum of $24,000.

Should I purchase an EHR now or wait until 2010?
An obvious concern is whether an EHR implemented in 2009 will meet the standards set by HHS in 2010. Although a legitimate concern, waiting until 2010 to implement a system may be a mistake. Researching and selecting the right EMR can be a lengthy process, and many providers who wait may find it difficult to have a system in place in time.

Practices would be well-served to begin the research process now, allowing ample time to create a short-list of systems, perform demos with several vendors, check references, meet with vendors in person, negotiate terms, and complete the implementation and training process. To alleviate buyers’ concerns, vendors may provide binding agreements, guaranteeing their system will comply with all emerging standards.

Furthermore, buyers’ should consider CCHIT an important Certification relative to the requirement for “qualified EHRs.” While we have discussed the many opinions for and against CCHIT, we expect it to play a critical role in the EHR subsidy qualification.

What if I choose not to purchase an EHR?
Unfortunately, for physicians who choose not to implement an EHR, the stimulus bill is a double-edged sword. Not only will they forego thousands in incentive payments, but starting in 2015, they will be penalized by way of decreased Medicare and Medicaid payments. Physicians who fail to qualify as meaningful users will face decreases of 1% in 2015, 2% in 2016, and 3% in 2017, with a maximum reduction of 5% by 2020.

Above article published on

http://www.softwareadvice.com/articles/medical/
the-stimulus-bill-and-meaningful-use-of-qualified-emrs-1031209/

Stimulus funds would help replace paper medical files.

By Kristi E. Swartz

The Atlanta Journal-Constitution

Hurricane Katrina illustrated what can happen when medical records are on paper instead of stored on a computer.

They washed away, rendering thousands of people unable to get prescriptions, notify doctors about allergies or receive medical help.

“We have to bring our best technology to bear in the health care system,” said Dr. David Satcher, former U.S. surgeon general and director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

Federal stimulus money is available for health care providers in Georgia to convert paper medical records to electronic ones, Satcher and others said Thursday at Georgia State University. Though such technology has been available for years, fewer than 4 percent of doctors have made their medical records completely electronic, said Janet Marchibroda, chief health care officer for IBM, who said the stimulus dollars will help with some of the conversion challenges.

Stimulus money will be funneled through Medicare and Medicaid programs as well as through the National Coordinator for Health Information Technology. Marchibroda cautioned that it be spent wisely.

“We could really mess this up by just pushing a lot of money out there but not focusing on improving health information technology,” she said.

Georgia’s Department of Community Health has received $339.6 million in the first batch of stimulus money. Rhonda Medows, the state’s health officer and commissioner of the community health department, said the agency is waiting for federal guidance on how it can use that money to reimburse health care providers who buy an electronic health record system.

Above article published on

http://www.ajc.com/services/content/printedition/2009/05/15/healthstim0515.html

Care for uninsured, electronic records receive cash

The $4 billion in federal stimulus health care money headed to the Bay State over the next three years will help provide care for those who can’t afford it and - it is hoped - help stem hemorrhaging health care costs by funding new technologies.

The bulk of the health care stimulus funding - some $3.5 billion - will keep most safety net programs afloat with Medicaid/Federal Medical Assistance Percentage funds.

But a portion of the federal stimulus money is targeted for cost-saving innovations. Massachusetts is getting $1.3 billion in technology and research funds, with more than $500 million going toward eHealth initiatives in the commonwealth.

The initiatives will fund the creation of electronic patient records. State officials hope the federal investment will lead to a secure statewide database of patient information, or in government parlance, an interoperable Health Information Exchange.

The program could have a long-standing impact by providing doctors quick, seamless access to patient records, offering the possibility of savings in time, money and lives. Nationwide, some $19 billion will go to e-records programs with a goal of freeing a profession from an archaic paper-based system by 2014. President Barrack Obama has touted the potential costs savings from the program.

Massachusetts, which is ahead of many states in initiating electronic medical records, stands to gain from significant federal reimbursements.

Stimulus funds will be used to reward those who have already installed the record system and provide money to hospitals and physicians who implement it. The state would also penalize those who fail to upgrade to e-records.

Physicians who meet the state criteria for electronic files could receive reimbursements of up to $44,000 each over four years directly from the federal government. There are about 20,000 physicians in the state, according to the Department of Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented a records system. With individual reimbursements for its 3,000 members, including teaching hospitals Brigham and Women’s and Massachusetts General Hospital, the health care consortium could receive from $10 million to $50 million.

The state’s Health Care Quality and Cost Council estimates that it takes a small medical practice an average of four months to adopt an EMR at an up-front cost of up to $40,000 per physician.

Up-front costs have been one of the biggest obstacles in creating an electronic system. But Massachusetts, which has nearly twice the national average of doctors using EMRs, could face an easier transition with quicker federal reimbursements.

“The adaptation in Framingham was smoother because there wasn’t an existing paper record, so our advisors picked it up very quickly,” said Paula Kaminow, executive director of the Framingham Community Health Center, which began using EMRs when it opened five years ago.

Community health centers are important centers of medical information because they serve a wide range of the population that doesn’t have personal physicians. Installation of electronic records in 12 centers could increase staff productivity, allow for expansion in the number of patients and ensure easier and faster sharing of patient information with hospitals.

“From a risk-management standpoint, it’s much easier for providers to find the information they need,” Kaminow said. “The handwriting is clean, you can find different chart notes very quickly and can integrate information from different sources.” The electronic system could save the nation $530 billion over 10 years, according to the Health Care Quality and Cost Council, which estimates that the stimulus’ national eHealth initiative could reduce the nation’s health care spending by up to 30 percent.

Kaminow said the most important characteristic for an electronic record is the ability to interface with other types of records.

“The challenge is to make sure that all the different pieces can speak to each other, such as a management system that can speak to an electronic health record or a lab report,” she said.

The central project for the state is the Health Information Exchange, which is not funded by federal dollars. The state’s newly established Health Information Technology Council will provide $15 million in initial funding to help install the exchange by 2014.

The exchange would combine electronic record projects for individual practices, hospitals and community health centers, sharing patient information in a secure statewide database. Anyone in the system treating a patient could quickly learn about the patient’s allergy data, medication and test results.

The IT initiative has another reward: job creation. Private sector jobs would grow among vendors installing database systems, with positions ranging from entry-level programmers to high-level project managers.

Massachusetts has a leg up in this respect with an already developed system of software and hardware vendors.

Although federal stimulus funds end after two years, the reimbursements that follow implementation of the systems could create jobs in the long term.

“We’re looking to bring on more staff and extend our hours,” Kaminow said. “After a start-up period, our costs are covered through billing, so in that way we’d be able to sustain increased employment.”

The other big slice of the health care stimulus pie is the $764 million coming to Massachusetts for this year and next.

Funds will be used primarily to maintain services - securing jobs, meeting health care standards and safety net services, with $190 million going to offset fiscal year 2009 budget holes, according to the Department of Health and Human Services.
Above article published on

http://www.thesunchronicle.com/articles/2009/05/12/news/4900258.txt

by Sven Gustafson | Oakland Business Review

Money included in the $787 billion federal economic stimulus package will allow Beaumont Hospitals to expand a new electronic medical records system to at least 300 of its affiliated physicians by year’s end, hospital officials said Thursday.

The Royal Oak-based health system launched its centralized EMR system at its Grosse Pointe hospital last year and at its Royal Oak and Troy hospitals on Feb. 1. The system, which is now in place with 136 affiliated physicians, is expected to streamline a complex web of mostly paper-based record-keeping, improve patients safety and lower costs.

“The opportunity for us in the stimulus package is to be able to more quickly push this out to the 3,000 doctors that serve our patients,” said Beaumont CEO Ken Matzick. “That’s where the maximum benefit comes from so that the physician who’s in his office is on the same platform as the hospital.”

The stimulus package signed by President Barack Obama earlier this week includes $19 billion to help hospitals implement more information technology, said U.S. Rep. Gary Peters, who toured the hospital Thursday to learn about the new system.

Peters, a Bloomfield Township Democrat who serves on the House Science and Technology Committee, said the panel will work with local hospitals to determine how the funding is allocated.

“Some of those next steps have to be developed… but they’re going to be developed very quickly,” Peters said. “The idea is to get this money out as quickly as possible to create those jobs in the short run and get this technology going.”

Advocates for years have argued for the adoption of electronic medical records as a way for health systems to save money by rooting out inefficiencies and waste. The Congressional Budget Office has estimated mass adoption could result in savings of $12 billion over 10 years.

But mass adoption has been slowed in part by costs and by a lack of a consistent operating system that can link providers, insurers and patients.

While hospitals such as Metro Health near Grand Rapids and various large group medical practices have adopted EMR technology, Beaumont is believed to be the first health system to become fully integrated in Southeast Michigan. The hospital has invested nearly $100 million over five years to bring the technology online but expects it to take a few more years to go completely paper-free in record keeping.

The new system still won’t necessarily be able to communicate with EMR systems from competing hospitals or outpatient facilities, said Paul Peabody, Beaumont’s vice president and CIO.

What’s needed, he argues, is more standardization across the health care industry for mass adoption and the ability to share data between different health systems. Such standardization, he said, should include consistent patient identifiers, a standard data format and consistent clinical nomenclature within those data envelopes.

“If we have those three things, we will have completely portable records because we have the Internet to be able to go and access information,” Peabody said.

Beaumont’s new system replaces a software system that pre-dates the Internet.

Features include the ability for doctors to access real-time patient information and treatment histories, enter computerized prescription information and patient instructions and immediate access to prior test results without having to call outside physicians. A separate program to be combined later this year will allow patients to view online chart information and review billing information and schedule appointments.

“It links the entire health record of patients I see in hospitals and ambulatory settings with information that I can see easily and that is highly accurate,” said Dr. John Tower, a rheumatologist at Beaumont’s Troy hospital.

“It’s a little bit of a learning curve but it’s a Windows-based platform that is intuitively user-friendly.”

Under the new system, doctors won’t duplicate tests because they can easily obtain copies of test results ordered by other physicians, Peabody said. Physicians will also be able to get patient information faster than they would having to phone other doctors.

“That then means faster decision making to apply to whatever that disease is that they’re treating,” Peabody said. “That has to lower cost. That has to create a better quality outcome for patients.”

Above article published on

http://www.mlive.com/businessreview/oakland/index.ssf/2009/02/beaumont_hospitals_expects_to.html

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

By Ken Alltucker

The Arizona Republic

Federal money could accelerate Arizona’s push toward digital health records, making staples such as paper charts, written prescriptions and doctor’s-office clipboards a thing of the past.

As part of its stimulus package, the government will pump more than $19 billion into computers and software systems that promise to connect hospitals, doctors, pharmacies and other health-care players.

Widespread use of electronic health records would save lives and money and eliminate waste in the complex world of health care, medical experts agree.

Arizona doctors appear to be adapting to electronic records faster than the national rate, but getting there can be costly and frustrating.

At Central Phoenix OB/GYN, the three doctors and a nurse practitioner started using a digital system in January. The doctors are still learning the system, and the office staff is on the final leg of scanning 20 years’ worth of patient records into computer records. “We are still in the ‘Oh, my God, what have I done’ (phase),” office manager Tracey Vega said.

Arizona’s medical community is poised to collect as much as $500 million in stimulus funds beginning in 2011, local officials estimate, provided health-care organizations adopt “meaningful use” of such digital systems.

“Automation is eventually going to be everywhere,” said David Landrith, the Arizona Medical Association’s vice president of policy and political affairs. Proponents say electronic health records are superior in many ways. A physician can verify a patient’s prescription-drug regimen, helping to avoid harmful drug combinations. Nurses can use a hand-held scanner to zap a patient’s medication to ensure they are giving the right drug to the right person.

Multiple caregivers can simultaneously view a patient’s medical charts, making care more efficient. Still, there are challenges. Some worry that a wide range of computer systems and standards may block effective communication. Systems that cost $100,000 or more are too expensive for smaller doctor’s offices. Comprehensive hospital systems can range from $20 million to $100 million.

Also, worries about patients’ privacy persist.

Arizona’s progress

Studies show varying degrees of adoption rates for computerized records. A New England Journal of Medicine survey indicated that 17 percent of doctors have some type of electronic health-records system, while another survey indicated hospitals’ use of electronic health records vary widely.

Arizona health-care providers have turned to computerized systems at a faster clip, with at least 30 percent of physicians employing some type of digital system, according to Brad Tritle, executive director of the Arizona Health-e Connection, a non-profit group established to orchestrate Arizona’s digital health initiative. Tritle said that figure comes from an ongoing survey of licensed doctors performed by Arizona State University and funded by the state’s Medicaid program.

Arizona’s digital health push isn’t new. While governor, Janet Napolitano signed an executive order calling for statewide adoption of digital-records systems for prescribing drugs. Arizona Health-e Connection has spearheaded the effort to research and develop model policies in the state.

With federal stimulus dollars providing a tailwind, Tritle said he expects the use of digital health records to accelerate.

Digital doctors

Even the biggest backers of a health-information revolution acknowledge that questions remain about cost, training and standards.

Dr. Bradford Croft, a family practitioner in Flagstaff, is one of Arizona’s digital pioneers, having tossed out paper records a decade ago.

Each room is outfitted with a computer. He chats with nurses or assistants via instant messaging. The conversion has made Croft’s practice more efficient, allowing him to see more patients each day. One reason: He doesn’t waste time writing notes only to have others duplicate note-taking several times.

“We’ve been more productive, without a doubt,” said Croft, who also holds an MBA and completed his master’s thesis on the efficiency of his practice.

Yet even Croft said his current system is less than ideal. He has cobbled together eight software programs to get everything he wants. He plans to spend up to $50,000 on a new system. Regardless, he said he cannot imagine going back to paper records. “Does it make us better doctors? Not necessarily,” Croft said. “But I think it makes us more organized, and it makes us more observant to detail.”

Dr. Lesley Johnstone at Central Phoenix OB/GYN said the conversion will make her office more efficient.

One example: A doctor could access a patient’s records and authorize a prescription refill with a few keystrokes rather than searching the office for a paper file.

Plus, the 24/7 availability of patients’ records will allow the doctors to more easily take care of the other doctors’ patients. When a doctor delivers the baby of a patient he or she is less familiar with, it is essential the doctor has access to the patient’s records.

That typically meant a late-night or early-morning call to locate paper records. Now, the on-duty doctor needs only to access a computer. Despite the knowledge that digital records will help make things easier, Johnstone said the transition has not been simple. “It was always really easy on paper, but for some reason, it is harder with the computer,” she said.

Leaders and laggards

Tritle said other areas of Arizona’s health care are considered leaders in digital health, too.

Banner Estrella Medical Center was among the nation’s first hospitals to go all digital when it opened in January 2005. Other hospitals that have established digital records include Banner Gateway Medical Center, Mayo Clinic, Cancer Treatment Centers of America and University Medical Center in Tucson.

One of Banner Estrella’s most recent initiatives is called “positive patient ID,” which aims to eliminate a common medical mistake: giving the wrong patient the wrong medication.

The system works by requiring nurses to use a hand-held device to scan medications to ensure they match a patient’s records. If the nurse has the incorrect room, they will get an alert from the scanner.

The program has cut down on medication errors, said Richard Schmidt, a registered nurse who serves as the hospital’s interim deployment manager. Banner Health plans to roll out such digital-records systems for all its hospitals over the next 18 to 24 months, spokesman Bill Byron said. Banner Health and other Arizona hospitals likely will seek federal stimulus dollars to help fund the transition. “We view this as an affirmation of what we’ve been doing,” Byron said of the stimulus plan.

Above article published on www.azcentral.com.