With federal stimulus money in the balance, many Kentucky medical providers are getting the nudge they need to transition to electronic health records.
The federal government in August announced grants of almost $1.2 billion to help hospitals and other healthcare providers establish and use electronic health records. Ideally, patients’ records will follow them wherever they are treated. Duplicative paperwork won’t have to be filled out at every turn, and medical history and previous test results will be accessible at the click of a mouse.
These digital records will give physicians a more complete vantage point from which to diagnose and treat patients, saving time, reducing costs and improving the quality of care. Having access to electronic health records will be especially helpful in situations where the doctor is unfamiliar with the patient and/or time is critical, such as in an emergency room.
“We are trying to move from an antiquated system to a modern system,” said Kentucky Lt. Gov. Daniel Mongiardo, a doctor himself, who is a strong proponent of healthcare reform. “Healthcare is the most information-intensive industry there is. Right now, it’s all clogged up with paperwork that is all over the place. There’s no instant access when we need it.”
Mongiardo is heading an effort in Kentucky to use the stimulus money to help create “a gravel road” where Kentucky doctors can exchange patients’ basic medical information electronically on a secure network. The state has created an e-Health Network Board, the mission of which is to support health information technology statewide.
So far, more than a quarter of Kentucky’s primary-care physicians have done away with paper records in exchange for the electronic version. And not only have most found it improves the quality and efficiency of patient care, they also have found it helps their own bottom line.
“Our return on investment came in less than 12 months,” said David Bolt, chief operating officer for PrimaryPlus, which runs five clinics in northeastern Kentucky. “If efficiently operated, you derive a lot savings – from no transcription, paper and storage space costs to better productivity and improved coding, charting and reimbursement.
“It also has been a tremendous marketing tool,” said Bolt. “People see we are using technology not being used in bigger cities. They see it’s a tool that helps us to better care for them.”
Still, with a flagging economy and healthcare in a precarious state, many physicians and physician groups have postponed or balked at investing the up to $30,000 it costs per doctor to make the transition. Cost considerations include not only initial installation but the proper hardware, maintenance, training and upgrades. Meanwhile many doctors are set in their ways and uncomfortable with making the transition. Plus, with so many systems out there, doctors aren’t sure which ones fit their needs.
One of the most definitive steps to help healthcare providers adopt electronic records will be to create systems that meld to the way doctors and hospitals deliver healthcare rather than the other way around, Mongiardo said.
“Right now the software is nowhere near where it needs to be,” he said. “The capacity of healthcare is already stretched, and doctors aren’t going to use something that slows them down.”
But by having the state first create a basic medical information exchange system, the medical records technology can grow around it, he said. Right now, several major information technology companies are devising healthcare information systems, he said, and Kentucky universities are ideal places to research what is out there and what is working, based on the evidence.
Bolt at PrimaryPlus also cautions physicians about choosing the right system for their practice.
“You need to take your time and not fall prey to bells and whistles,” Bolt said. “You need to look at functionality. Also, you can’t bring a new system into an inefficiently operated clinic. There’s no advantage unless you are prepared and efficient.”
Dr. Carol Steltenkamp, chief medical information officer at the University of Kentucky and co-chair of the state’s e-Health Network Board, said compared to other states’ adoption of e-health technology, Kentucky is running middle of the pack.
“Our challenge is similar to those of other states – funding,” she said. “There’s a cost associated with this. Physicians have to see the value of going electronic. The challenge is the same whether it’s a small practice or the commonwealth of Kentucky.”
With the help of the federal stimulus dollars, she anticipates the number of doctors on board to significantly increase during the next five years. Individual physicians, non-hospital based, are eligible for up to $44,000 over four years if they achieve “meaningful use” of electronic health records, she said. Larger institutions, such as the UK Chandler Medical Center, are eligible for much more based on a federal formula.
Steltenkamp said UK is well on its way to meaningful use, having almost completely adopted e-health records on the in-patient side and moving toward the same end on the outpatient side.
Meanwhile in the Bluegrass, the Lexington Clinic has been a leader in the transition to electronic health and medical records. Being a large entity of 1,000 employees and more than 150 physicians in 20 locations, the Lexington Clinic was able to use its own information technology department to develop a workable system.
The system, which was first tested in some outlying offices in 2004, not only allows doctors in its multiple locations to securely exchange patients’ health information, it also gives emergency room physicians at St. Joseph Hospital access when a Lexington Clinic patient is seen there.
The new system has improved communication and provided better availability of information, said Lexington Clinic CEO Dr. Andrew Henderson. When a patient is referred from a primary care physician to a specialist within the organization, his or her records are immediately available. Results of MRIs and X-rays can be transmitted in real time. And when a Lexington Clinic physician prescribes medication, the prescription is immediately sent electronically to its pharmacy, if the patient desires. The pharmacist, meanwhile, has no worry about making mistakes from misreading the physician’s handwriting, Henderson said.
Among the non-medical advantages are the freeing up of space previously taken up by medical records (which must be held for at least 10 years after an encounter with a patient), the elimination of time and personnel involved with the transport and storage of those records, and better security. Contrary to what people may believe, electronic health and medical records (backed up at a remote location) are much more secure than paper records, said Dr. Robert Bratton, chief medical officer of the Lexington Clinic.
“Seven people touch a written chart before it reaches a doctor’s hands,” he said.
The physicians at the Lexington Clinic use wireless tablet computers to access records and to input their own information. With a couple of clicks, Bratton said, a specialist can send information back to the referring physician. Before, the specialist would have dictated a note or letter and had a staff member mail it. When it reached the referring doctor’s office, a staff member would have to make sure it got into the patient’s medical file, not only taking more time but leaving more room for error.
Bratton said electronic health and medical records allow for much greater safety all the way around, which benefits both the patient’s health and the doctor, who can worry less about the potential for malpractice.
Bolt, who also serves on the state’s e-Health Network Board, said he is more excited about the direction healthcare is headed than he has ever been in his 40 years in the field. With the electronic exchange of information, healthcare will be better managed in the hands of the providers and patients, with substantial savings to patients, insurers and federal entitlement programs such as Medicaid and Medicare.
“This will help bring the disparate parts of healthcare together,” he said. “This won’t be a platform to just run programs but, instead, a process to improve health.”