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Shift may take time; medical-records conversion costly
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Published: April 6, 2009
Converting medical records from paper to electronic filings is shaping up to be one of the final frontiers on the information superhighway.
The federal government, through the recently passed stimulus package, is trying to accelerate the pace with a financial carrot-and-stick approach that may not be enough to assure total compliance, according to analysts and local health officials.
The package gears $19 billion for health-care information technology, including $17 billion in incentives to encourage doctors and hospitals to operate primarily electronically beginning in 2011.
That includes incentives ranging from $2 million to $6 million for local hospitals, and from $45,000 to $60,000 for local physician offices, to help pay for installing electronic medical-record systems.
For procrastinators, or those who don't want to pay the cost of installing the new system, there will be an $8,500 fine beginning in 2016.
Among the Obama administration's goals are stimulating innovation and generating cost-savings through improved care coordination and reduced medical errors. That includes clinician order entry, electronic documentation and the transfer of prescription data from physician to pharmacy.
Local health-care officials, as well as analysts, say that while the incentive money will help, it won't cover the cost of the conversion.
For example, a study by Avalere Health released in March found that physicians in small practices will have to pay an average of $124,000 between 2011 and 2015 to adapt to an electronic medical-record system. The costs were estimated by the Agency for Healthcare Research and Quality.
That would leave those physicians paying between $64,000 and $79,000 on their own. That's not including an estimated monthly $1,500 in upkeep and training costs.
"Absent a leap-of-faith that new health-care information technology will increase their efficiency, up to half of physicians -- those practicing solo or in small groups --may perceive themselves better off financially by forgoing the investment, and instead paying a penalty for non-compliance," Avalere said.
Novant Health Inc. and Wake Forest University Baptist Medical Center said they already have been converting to electronic medical filing.
"The rollout of our ambulatory electronic medical record system continues to be a multi-year task across our Novant Medical Group practices," said Dr. A.J. Patefield, the chief medical information officer for Novant Health. "The components of these hospital and ambulatory systems are numerous.
"Our system at Forsyth Medical Center includes a single inpatient electronic-record system for laboratory and radiology results, and document sharing retrievable across any facility, physician offices and remotely from the Internet.
"We continue to use our paper documents for the legal patient record, however," Patefield said. "We have very few physician-order entry systems."
Patefield said that the cost of installing and maintaining the electronic medical-record system will be in the tens of millions of dollars for Novant and other regional health-care systems.
"The cost burden is significant, but it is an important investment to deliver safe patient care," Patefield said.
A Winston-Salem software company, Talon for Healthcare, expects to benefit from the stimulus incentives -- once it is clearly defined what constitutes an electronic record under the plan.
"Where we fit in is providing increased efficiencies in the health-care networking system," said Lynette Mutter, a business-development official for the company. "Better communication is critical in lowering the potential for malpractice suits in terms of how patients perceive their care and not building up false expectations."
Mutter said that electronic medical data can assist in providing:
□ E-mails to patients to remind them about what was discussed during their doctor visit;
□ Documentation that a patient has or has not read or viewed materials about their case, including a check-off for whether they understood the materials;
□ Help with avoiding duplicative tests if a patient is transferred from one health-care provider to another by providing documentation that those tests were done.
John McConnell, the CEO of Wake Forest Baptist, said that the impetus toward electronic medical filing could help the system's ability to do broader research, which in turn could help raise its profile nationally -- a prominent goal within the health-care system.
A commentary by a Wake Forest and Duke University researcher said that when electronic health information is created for every American by 2014, "a massive amount of medical information will suddenly exist in a new form, for which no clear ownership laws or regulations exist."
"This impending legal issue must be addressed very soon if we are to both protect patients' interests in their medical information and ensure that new information systems are put to their best uses," said Mark Hall, a professor of law and of public health sciences at Wake Forest and co-author of the commentary in the Journal of American Medical Association with Dr. Keith Schulman of Duke.
■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.
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