Some doctors find switch to electronic medical records painful

The switch to electronic medical files proves a painful procedure

jmurawski@newsobserver.comNovember 3, 2012 

  • What’s behind the push for electronic medical records Electronic medical records, a major part of the Obama administration’s strategy to cut medical costs, are driving a massive technology shift in the health care field. The American Recovery and Reinvestment Act of 2009, commonly known as the federal stimulus bill, includes bonuses for doctors and hospitals that achieve “meaningful use” of electronic records with Medicare and Medicaid patients. Failure to meet the federal goals with Medicare patients triggers penalties. For doctors, the maximum federal incentive for electronic records is $44,000 under Medicare and $63,750 under Medicaid. Failure to use achieve “meaningful use” targets triggers penalties in 2015. The penalties start with a 1 percent reimbursement reduction in the first year, and increase to 5 percent over time. The Medicare incentive is available to dentists, podiatrists, osteopaths, optometrists and chiropractors. The Medicaid incentive is available to nurse practitioners, nurse midwives, physician assistants and other types of medical providers. Under the “meaningful use” standard, the majority of prescriptions, diagnoses and other procedures must be processed and stored electronically. Hospitals could receive incentives worth several million dollars. The hospital incentives are based on complex formulas, starting with a base minimum payment of $2 million a year that is adjusted on a range of factors. John Murawski

Phil Talbert took the plunge and bought an electronic medical record system for his small medical practice in Shelby in 2010, assuming the pricey computer program would last years, perhaps a career.

Then a month ago, just as Talbert was getting comfortable using the system and appreciating its potential, the physicians assistant got a jolt: The service, called MyWay, was being discontinued. The technology, which doesn’t work on smartphones and tablets, is already obsolete.

MyWay, in use by more than 4,000 doctors nationwide, had cost up to $30,000 per doctor to install, or about $600 a month per physician as a subscription service.

“We bought what we bought thinking it was a stable company and it was their newest package,” Talbert said. “You spend all this time transitioning to a program, and they come back and say, ‘Sorry guys, we’re not going to do this after Jan. 1.’ ”

The scenario is playing out throughout the state and the nation at a critical time when electronic medical records are no longer optional for doctors and their patients.

The service cancellation by Chicago-based Allscripts, which employs 1,200 people in Raleigh, is believed to be the first instance of a major vendor of electronic medical records pulling the plug on an electronic medical records system.

In an industry crowded with hundreds of such vendors offering more than 1,000 electronic medical records programs, Talbert’s situation is expected to repeat itself across the country as bigger companies gobble up smaller ones and software programs become redundant and obsolete.

The major driver for a wholesale changeover to a new generation of electronic medical records is the Obama administration. As part of the president’s move to cut health care costs and improve medical service, the federal government is offering as much as $22.5 billion in incentives for adopting computerized patient records – up to $63,750 per doctor – and also planning to ding doctors who don’t use electronic systems for their Medicare patients with penalties up to 5 percent. Additionally, hospitals could receive several million dollars a year for meeting federal Medicare performance targets, and face penalties for noncompliance.

‘Overall, it’s better’

All three major health care systems in the Triangle – Duke University, UNC Health Care and WakeMed – are in the midst of a massive transition to electronic medical records that will connect doctors, hospitals, clinics, pharmacies and pathology labs on unified networks that doctors will be able to access from a home computer or smartphone. These sprawling corporate health systems will spend hundreds of millions of dollars over the next several years replacing electronic medical networks at doctor offices and training several thousand physicians and nurses on the new systems.

Most doctors, those not affiliated with giant health networks, will be shopping on their own for electronic systems. They will bill fewer patients and work longer hours for several months until they attain competence. Some will be updating medical practices that still rely on the ancient system of paper records stored in file folders.

Nearly three-fourths of North Carolina’s doctors use electronic records, according to the nonprofit Physicians Foundation. But many of those systems are not yet fully interconnected with each other, requiring receptionists to make phone calls to order lab work, or to fax in prescriptions.

“Overall, it’s better than using paper records, but I don’t think anyone is 100 percent happy with it,” said Terry Brenneman, a Raleigh pediatrician.

‘In your face for safety’

The hodgepodge of systems in use today is reflected by a mishmash of doctor attitudes. About 50 percent of North Carolina’s doctors say electronic records have not improved the quality of treatment, or have decreased quality, or are simply not worth the expense, according to a September survey by the Physicians Foundation in Boston.

The shift, however, is inevitable and embraced by a growing cadre of doctors, who swear by the technology and say patients receive better care from programs that flag dangerous drug interactions, send prompts and reminders, sort patient data, and plot charts into meaningful patterns.

“It’s in your face for safety,” said Charles Cooperberg, a Durham nephrologist who uses a program called Allscripts Professional, and whose 12-person practice netted $18,000 per doctor in federal incentives in 2011. “Multiple people can have the chart up at the same time. It doesn’t really matter. Everything’s everywhere.”

The trio of major health systems in the Triangle have been using a patchwork of electronic records for years, adding so many systems over time that they now have several hundred separate programs that have to be cobbled together with patches and interfaces.

WakeMed Health & Hospitals, with a network of 250 doctors, uses 130 systems of bedeviling complexity. When the WakeMed system made an internal change, reclassifying NICU from Neurological Intensive Care to Neo-Natal Intensive Care, the new classification required a month and a half of reprogramming, debugging and testing.

“If something that simple takes six weeks, we came to a conclusion that we had to make a change to a single system,” said Denton Arledge, WakeMed’s chief information officer. “All these very large hospitals in the state have the same issue.”

Hospitals choose systems

WakeMed expects to spend more than $100 million over five years on new software and implementation. For its trouble, the health care company is also counting on federal incentives of $15 million to $18 million.

Duke University Health System is replacing 135 electronic networks with a single system at a cost of more than $500 million over seven years. The federal incentive likely will come to about $50 million, said Tom Owens, chief medical officer. Over a two-month period next year, the Duke health system will train 7,000 people on the new network, he said.

The UNC system, which includes Rex Healthcare in Raleigh, expects to select a vendor this month. The health system uses several hundred software applications to manage records, billing, scheduling and other functions.

Patients will see big changes, too, when they are processed through a single health system. For starters, they will get one bill instead of sorting through a confusing array of multiple bills sent from different departments.

“They will all get one bill. At a minimum, you get two bills now,” said Linda Butler, chief medical officer at Rex Healthcare.

“Patients won’t have to retell what medication they’re on 17 times because the systems don’t communicate with each other,” she said.

Talbert is dreading the change he’ll have to make. He said his practice had to cut its workload in half to learn how to use the MyWay system sold by Allscripts.

Aprima to the rescue

When Allscripts said Oct. 5 that it would discontinue MyWay, competitor Aprima announced that Allscripts was “abandoning” its customers. Dallas-based Aprima has since retracted that characterization but says in its statements that it is “rescuing” MyWay users.

Aprima has offered to give MyWay doctors an $8,500 software license for free for switching to Aprima’s electronic medical records system.

Allscripts is offering to upgrade Talbert and other doctors from MyWay to a different Allscripts software program, called Professional, at no extra cost.

“Ease of use was really critical to our decision here,” Allscripts President Lee Shapiro said of the MyWay phase-out.

The company says 180,000 doctors use its electronic records software, about a third of the nation’s practicing physicians, Shapiro said.

Cooperberg, the Durham kidney specialist, said computerized patient records are essential in his specialty, where patients sometimes use a dozen drugs and have multiple illnesses that must be monitored carefully.

“No one could read my writing – I couldn’t read my own writing,” Cooperberg said of his scrawled prescriptions, a common complaint in the medical profession. “I could never go back to paper.”

Murawski: 919-829-8932

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