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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.
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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.
No cost systems are available and the cost to implement is the time it takes for the staff and the physician to learn. The focus should be more on improving patient care and allowing the flow of information, meds, labs etc. so that better decisions can be made. So, if you want a no cost system, and want to improve patient care it is possible.
There is more than one system out there that was developed for physicians by a physician.
What do you think?
I was disturbed that the general tone of this report was focused upon the cost of updating to EMR/EHR technologies. I agree with the above comment that, often, a physician or hospital is paying for software that is poorly suited to their tasks and not really customizable. Two Open Source products are available that can mitigate some of the costs and are relatively extensible and customizable yet they were not mentioned in the report. They are OSCAR (from McMaster Univ) and GnuHealth.
OSCAR is available at:
http://oscarmcmaster.org/
and GnuHealth is available at:
http://health.gnu.org/index.html
Please advertise these products whenever possible if you want to contribute to efforts to lower health care costs.
I was disturbed that the general tone of this report was focused upon the cost of updating to EMR/EHR technologies. I agree with the above comment that, often, a physician or hospital is paying for software that is poorly suited to their tasks and not really customizable. Two Open Source products are available that can mitigate some of the costs and are relatively extensible and customizable yet they were not mentioned in the report. They are OSCAR (from McMaster Univ) and GnuHealth.
OSCAR is available at:
http://oscarmcmaster.org/
and GnuHealth is available at:
http://health.gnu.org/index.html
Please advertise these products whenever possible if you want to contribute to efforts to lower health care costs.
The concept of a medical record which is accurate and universally accessible to care providers by internet is sound. What we have, in reality, is a number of overpriced obsolete programs which meet neither of those goals. The electronic health record industry existed for 30 years to serve a small niche. Recent regulatory requirements and government incentives have thrust the industry into a more global position in the United States. Unfortunately, the software remains old and inadequate to the task while software companies struggle to modify their products to meet regulatory requirements. Usability and safety are secondary concerns. The real story about the electronic record, from the standpoint of the business journalist, should be that we are pumping inordinate amounts of money into an industry whose product is obsolete, probably unsafe and simply not up to the task of helping physicians do a deceptively complicated job. I have no doubt, based on other products that I use in my personal life, that the IT industry will eventually produce products that meet the promise. I am guessing that this process will take about 10 years. Until then, don't get sick.
As a physician who has been using and involved with electronic records for well over a decade, their touted benefits do not approach reality. Administrators and bureaucrats love them because they can track everything and eliminate jobs and costs by passing the work onto physicians, nurses, therapists and others. We are now typists, transcriptionists, file clerks and many other roles beyond the one who provides services. While electronic records may work well for simple issues or lazy people, none are well-designed for cognitive specialties or complex cases because the data needs to be put in via free text or dictation. This makes chart notes to be image/word processing documents rather than interlinked databases, thereby eliminating the benefit of the computer to sift through large amounts of data for retrieval or analysis - for the clinicians. While I can access some data (eg, diagnoses) from the billing system, I cannot do the same from the clinical record. Further, it takes me far longer to chart a note now on any of the 3 systems I must currently use (2 hospital and 1 office) than to see a patient and/or write a note. My days are much longer and more frustrating trying to appropriately chart what I have done. Finally, systems designed for hospitals are not necessarily appropriate for offices and vice versa, so I hope Dr. Tinker's system will meet her needs.
I accept the necessity and benefits of computerization - and there are many - as well as the fact that there are no perfect systems. I accept that many physicians have systems that they love and make their lives better. I look forward to meeting them and finding out if their system would also meet my needs. I am sure that at some point clinically relevant and efficient systems will appear. But the current systems all have what I consider to be basic and inexcusable flaws, their costs are excessive and grossly underestimated by not including the excess time and effort required to learn how to use it and the alleged incentives or reimbursements are totally inadequate. Most of us are sold products that can't do what was advertised or what we need. We are then told that since the system is infinitely customizable, it's up to us to personalize it to meet our needs. It's like buying a Mercedes or Rolls-Royce, given the parts and told to "customize" it into whatever you like. To paraphrase Dr. McCoy from Star Trek, "Dammit Jim, I'm a physician, not a computer programmer!"
The thing that worries me about transitioning from old, paper records are the number of transcription errors that are inevitable and could be dangerous, so this is an undertaking that should be done professionally and with a system of checks.
In that regard, the government should step up and proffer upfront funding for smaller offices (and maybe even some not so small) to go electronic. The collective national healthcare equation would be better off and the sooner, the better.
