Doctors being pushed to use electronic medical records
Payment rewards, penalties tied to 2015 deadline
August 16, 2010
Patient histories, growth charts, immunization logs and X-rays bulge from racks of color-coded file folders lining the walls at Pediatrics by the Sea in Delray Beach, where Dr. Karen Kuhns and a partner see 4,000 patients.
But the two doctors have just ordered a new computer system to begin a paperless future, as the federal government is pushing the nation's doctors and hospitals to do.
New federal standards unveiled last month require doctors to start using electronic medical records routinely, including logging patients' diagnoses and visits, ordering prescriptions, monitoring for drug interactions and making records accessible to other medical providers. Advocates say meeting the "meaningful use" standards will save lives, prevent errors, reduce waste and save money.
To make it happen, Congress is wielding carrots and sticks. Doctors who use electronic record according to the standards by 2015 can collect as much as $64,000 each in federal stimulus funds to help them buy hardware and software. Those who don't comply by that date will see their Medicare or Medicaid payments trimmed by one percent per year.
Only about 20 percent of South Florida medical providers use electronic records now, experts said, and while many doctors are already making the change, some fear that older family physicians may one day close their practices rather than spend the money and time to go digital.
"There is some opposition," said Lisa K. Rawlins, executive director of the South Florida Regional Extension Center, a new nonprofit group that has an $8.5 million federal grant to help the local medical community make the transition.
"We have a lot of challenges ahead of us. Our goal is to help 1,500 doctors" of the 10,000 active in South Florida, she said.
Health care experts have estimated the cost of not having electronic medical records at nearly $78 billion a year. That includes the costs of sending lab results between hospitals and outside laboratories, needlessly duplicating medical procedures and shuttling paper charts among doctors.
Just eliminating phone calls between doctors and pharmacists would save at least $2 billion each year, according to a 2005 study funded by the nonprofit research group Center for Information Technology Leadership.
Instant access to information also could save lives. The first day Orlando Health hospital system launched its electronic records in 2001, a woman age 82 was rushed into the ER unconscious after a car accident. Before starting to treat her, doctors entered her name into their computer and found she was on the highest dose of blood thinners from an operation the week before.
"If we hadn't had that software, we surely would have killed this woman," said Becky Cherney, president of the Florida Health Care Coalition in Orlando, who has held seminars for South Florida doctors about the switch to electronic records.
Cherney's group has spent a decade linking local hospitals and doctors to a Central Florida database of millions of patients, the kind needed for emergency rooms to quickly learn about patients who had never been to that hospital. The database is due to come online this fall for a one-year pilot study.
Rawlins' group is working to create a similar system linking hospitals and doctors in its turf, which runs from Broward County to Key West but may soon expand to Palm Beach County and several counties to the north.
A patient database could greatly benefit public health, too, said Alan Spitzer, a neonatal researcher at Pediatrix Medical Group in Sunrise. Keeping track of how many children are injured in accidents such as pool drownings or head injuries can alert doctors to troubling trends in real time.
But the cost of purchasing and maintaining the systems is steep, and health care providers said the stimulus grants will not always offset the full cost.
Kuhns and her partner will probably break even, or better. They chose to buy a simple $6,000 system of laptops or tablet computers for entering data, which then gets stored by an online service costing several hundred dollars a month.
In contrast, Delray Beach family physician Dr. James Byrnes said he went bigger last year, buying a powerful in-house system of portable computers and a server for $38,000, plus $22,000 in staff training and $1,000 a month for data storage. His maximum grant would be $44,000.
"For four or five years, it's going to cost me money. But in the long run it's worth it," Byrnes said. "I can document better with my records. It's better for the patients. I can get paid better [because] I can prove what I did. And for the health system into the future, it's definitely a good idea."
Hospitals can expect to collect tens of millions each in stimulus funds to help pay for their record systems, Rawlins said. Some hospitals have said that may only cover part of their costs.
Not everyone is on board with the changes.
Some primary-care physicians worry that electronic records will create more work – such as filling out a questionnaire about each patient and clicking boxes on computer forms — and take away time that should be spent face to face with the patient.
"Once you learn it, it might be faster. But not at the beginning," Kuhns said.
"A lot of the doctors are being dragged into it against their will," said Hollywood surgeon Dr. Arthur Palamara, who supports electronic records but says the systems are "not ready for prime time."
Some physicians have voiced concerns over whether the systems can protect patients' privacy.
Others worry that the systems they buy today will be outdated in a few years and will have to be replaced, or that the data services endorsed by the government may not survive.
Still, doctors are embracing the change.
"This is a big undertaking for a small office like ours," Kuhns said, "but it's the right way to go."
Marissa Cevallos can be reached at mcevallos@orlandosentinel.com or 407-540-3531.
Copyright © 2010, South Florida Sun-Sentinel
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