Rural doctors slow to adopt electronic medical records

Rural physician Hope Tinker is transferring all of her paper records to an electronic system, thanks to the financial backing of a new partnership with a county hospital system.

With the help of electronic health records, rural physician Kevin Frazer (left) discusses the vaccination schedule for one-year-old Caroline Young with her mother Shauna Young.

These days when you go to the doctor, many rely on an electronic health records system. With just a few clicks of a mouse, they can bring up your medical history, prescribe you medication, or chart your test results.

The 2009 Recovery Act actually set aside $20 billion to help health care providers ditch the paper records and go electronic. The idea was to cut soaring health care costs in the U.S. But while physicians backed by large health care groups can afford the system, many rural physicians are struggling to make that transition.

At the Fayette Medical Clinic in rural Missouri, Shauna Young brings her one-year-old daughter Caroline in for a checkup. Dr. Kevin Frazer pulls up a graph of Caroline’s weight on the computer in the exam room.  Because Caroline’s electronic health record shows her weight has dipped, Frazer talks to Shauna about Caroline’s eating habits.

Health care providers generally have accepted electronic records as an efficient tool. It can cut costs and time. Frazer says he can use the computer to help diagnose conditions, bill patients, and show them changes in their weight or glucose levels.

“It gives us more information that the patient can see in real time,” Frazer says.

The federal government has set a deadline. If health care providers don’t implement an electronic health records system by 2015, they’ll get dinged with Medicare penalties. The problem for many rural health clinics is they don’t have the money to make the switch.

A study by the National Bureau of Economic Research last year suggests that costs rise sharply in the first year of adoption for health centers in less tech-savvy locations. And they can remain up to 4 percent higher for years.

There are big upfront costs for licensing the software and purchasing the computer equipment, according to Brock Slabach, senior vice-president of the National Rural Health Association. “It could be $30,000-$40,000 per physician possibly in terms of getting one of these set up in a clinic -- possibly more depending upon the complexities that might be present within that particular facility,” he says.

Those complexities often include adding a broadband connection, training staff to use the system and convincing patients they won’t lose their personal relationship with their doctor.

Across Fayette’s town square is Family Health Inc. Behind the receptionist, you’ll find about a dozen metal bookshelves packed with yellow file folders. That's because Dr. Hope Tinker still uses a paper system.

“My financial resources as an independent physician are limited,” she says.  “If you’re in a big group and you’re a primary care physician you reap the financial benefits as having access to their technology.”

While Frazer’s clinic has benefited from being part of the massive University of Missouri Health Care, Tinker has been on her own. That’s changing this month, though, when Tinker’s practice becomes part of a county hospital system -- something she says was necessary to survive and remain in Fayette. The larger organization will foot the bill to update her practice with electronic records and a T-1 connection line to hook into the hospital’s network.

Now, there is federal incentive money available to help health care providers go electronic. Many of the big health care groups are using it. But that money only comes as a reimbursement after physicians have installed the system. And in 2015, those funds disappear -- right when the Medicare penalties kick in.

That’ll affect doctors, like John Ward of Boonville, Mo.

For every year that I don’t participate in electronic medical records, they dock me a small percent,” he says, “and it will get bigger as the years go by to the point where it would be prohibitive to see Medicare patients.”

Ward, who is past retirement age, says he is opting out of the electronic world. It’s partly the price but also he wants to maintain face time with his patients.

“I fully recognize that I’m a dinosaur,” he says. “And in time, I and people who think like I do will die out and that electronic medical records are here to stay. That’s the way it’s going to be and we just have to get used to it.”

Ward does say if he were younger, he would take a harder look at making the financial leap for an electronic system.

With the help of electronic health records, rural physician Kevin Frazer (left) discusses the vaccination schedule for one-year-old Caroline Young with her mother Shauna Young.

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