CHARLESTON, W.Va. – 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 more than $19 billion in stimulus money.
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.
“I’m afraid of the way the technology is being forced on physicians before it’s really ready,” he said, adding that family physicians have a hard time with the prospect of spending tens of thousands of dollars to install the systems.
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, Reese 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 about 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.”
Subscribe to the Morning Review newsletter
Get the day’s top headlines delivered to your inbox every morning by subscribing to our newsletter.