Doctors' Orders

The implementation of an electronic medical records exchange has been delayed

The widespread use of electronic medical record-keeping is coming.

"The next generation of physicians doesn't even worry about the use (of electronic medical records)," observes Steve Nash, of the Pima County Medical Society. "They can't believe it isn't the norm now."

On the other hand, Nash says that when it comes to older doctors, "A lot of them trust paper records more."

President Obama's administration strongly promotes the use of electronic medical records (EMR). According to the Department of Health and Human Services, "Electronic health information exchange promises an array of potential benefits for individuals and the U.S. health-care system through improved clinical care and reduced cost."

Near the end of 2008, the local EMR objective was to offer a service to doctors and other health-care providers that would move them toward electronic record-keeping. This information could be exchanged between physicians' offices and emergency rooms.

Back then, Kalyanraman Bharathan, director of the Southern Arizona Health Information Exchange (SAHIE), had a goal: He wanted to see medical information being electronically exchanged within one year. (See "Healthy Sharing," Nov. 6, 2008.)

However, that hasn't happened, in part because federal stimulus funds later were promised to help defray part of the cost of the changeover—and that money has yet to be distributed.

"Electronic medical records at first decrease productivity," Bharathan says about introducing them into a physician's practice. "There's a learning curve required."

Bharathan estimates that switching to an EMR system could cost a practice between $100,000 and $300,000.

To encourage that switch, the federal government is offering financial incentives. From 2012 to 2016, physicians who participate in either Medicare or AHCCCS (Arizona Health Care Cost Containment System) can receive up to $63,750.

If physicians don't get involved, starting in 2015, small Medicare penalties could be assessed.

"The stimulus money and penalties put spurs into doctors," says Nash. "They must consider EMRs, especially for prescriptions."

According to the Arizona Governor's Office of Health Information Exchange, only 18 percent of prescriptions were filed electronically in 2009—but that number was up from just 8 percent two years before.

In general, though, Nash thinks many older doctors won't give up on their paper records. "If they plan on retiring by 2020," he suggests, "they'll take the (Medicare) penalties and won't change."

Bharathan says participation in a local EMR-exchange program would be a subscription service. He indicates that an EMR-lite program could initially be offered to a physician at a fairly low price.

"We don't want to limit their choices," Bharathan says of doctors considering the shift from paper.

The wait for the availability of federal funds to help defray some EMR costs wasn't the only cause of the delay in implementing a local program. A second cause was SAHIE joining last year with another organization to form the Health Information Network of Arizona (HINAz).

The HINAz board of directors has 23 members, including representatives of hospitals, insurance companies and governments. The Pima County Medical Society is also involved.

"We're offering the same services as SAHIE," Bharathan says—except those services are now offered on a statewide basis. He is interim executive director of the new organization and says services will include a marketplace-competition aspect.

"Getting the records to emergency rooms is still the starting point," Bharathan explains. "(ERs) would be provided (a patient's) lab reports and medical histories and send ER-discharge information."

Bharathan expects HINAz will select a private vendor within a few months to start developing the technology required to accomplish this goal.

For its part, the federal government has set its own goal for EMR. They want "most Americans to have electronic health records by 2014."

While Bharathan believes that's unrealistic, the state's Government Information Technology Agency thinks it can be accomplished. "GITA believes that most Americans will have all or part of their health records available electronically by 2014," writes the agency's Ryan Sommers in an e-mail.

Statistics from the state's 2011 Health Information Exchange Strategic Plan indicate how ambitious that goal is in Arizona. According to the plan, only 25 percent of the state's solo practitioners currently utilize EMRs.

Another potential problem with a quick transition to EMRs involves confidentiality issues. While Bharathan emphasizes that patients must have the ability to opt out of providing an EMR, privacy concerns going beyond that have been raised.

"People don't want employers or insurance companies getting the information," suggests Stewart Grabel, of the Pima Council on Aging. "Yet they're the most likely to get it, because they're paying for it."

However, Grabel—also a member of the HINAz board of directors—adds: "It's very important to protect medical records from the wrong people, but it seems illogical not to use the information to get better health care. ... I can think of up to a dozen cases where people were injured by disclosure of their medical records, but hundreds of cases where (the records) weren't available."

Specifically, Grabel says he knows of situations when it has taken a couple of weeks for a primary-care physician to find out what happened to a patient during an emergency-room visit.

For his part, Nash puts the EMR confidentiality versus improved health-care debate into perspective.

"The risk to a person is low for security," Nash says, "but higher if they're in an accident (and don't have an EMR)."

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