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Part 1: Is Your Doctor Using Electronic Medical Records?

Does your doctor walk into the examining room with a folder with your name on the tab,   stuffed with odd bits of paper, hand-written notes, old forms and ragged-edged test results?   If so, he or she has until 2015 to move all that information to an electronic medical record (EMR) or face financial penalties.

EMR is one aspect of President Obama’s health reform plan that’s supported by both political parties and, with some reservations, by most of the public.  This didn’t come out of the recently passed health reform bill, however, The Health Information Technology for Economic and Clinical Health Act (HITECH) was passed as part of the 2009 stimulus package.  It provides $19 billion to encourage health care providers to adopt electronic medical record keeping.  Is EMR really all that important?

All major industries are computerized and electronically record customer and supplier information.  Given it’s size and importance, it’s amazing that a patient’s medical history is kept on bits of paper in bins distributed among several doctors’ offices.  These vital records are impossible to back up, time consuming to keep track of, difficult to make available to other health providers, easy to misplace, susceptible to patient mix-ups, and expensive to store.

In contrast, EMR system software has been developed to store all the patient’s medical data: physiology, current medications, medical history, ongoing conditions, insurance coverage and test results. The information is stored in easy to access standard formats and can be backed up, protected, and stored on tiny disk drives.  Advanced systems can call out dangerous drug interactions and guide medical staff in making proper decisions given the symptoms entered and the patient information on file.

But EMR is just the beginning. The ultimate goal is Health Information Exchanges (HIE), networks that can share a patient’s EMR with all the health providers an individual interacts with.  For this, $700 million dollars is being made available to states to begin development of Regional Health Information Organizations (RHIOs), medical networks, that will enable medical facilities and doctors in a region to have access to the medical records of the patients they jointly care for. With both EMR and RHIOs in operation, medical experts see $77 billion a year in savings as well as improved patient care.  It would seem that going digital would be a no-brainer.

To date, however, only 25% of the nation’s hospitals are operating with electronic health systems and only a small fraction of physicians practices have done the same.  It’s because medical facilities, face major hurdles in converting their paper systems to electronic systems.  HITECH incentives paid over 6 years won’t cover the average cost of $30,000 per physician to implement the system or the $9,000 annual maintenance cost.  Staff must be trained and a period of frustration and inefficiency must be endured. To busy, cost-conscious doctors, the cost and effort are daunting.

Hospitals face similar challenges.  In 2002, Cedars Sinai Hospital in Los Angeles cancelled a $30 million system rollout when it so encumbered the work of doctors and staff, that patients were at risk.  The hospital had to start over.  In stages, they modified the software, trained personnel and adjusted existing procedures.  Today, the new system is operational in just one department with a gradual rollout scheduled for the rest.

Medical experts, nonetheless, feel that the financial incentives offered in the HITECH bill will move EMR forward.  In order to qualify for the funds,  medical providers must prove that they not only have installed the necessary equipment, but that they’ve used it to improve patient care.  The initial list of 20 objectives and measures of what is now known as the ‘meaningful use’  requirements was recently released. It calls for doctors and hospitals to comply with 10 base measures and their pick of an additional 5.

Included in the list of ‘meaningful use‘ requirements are:
- provide patients, upon request, with an electronic copy of their health information
- generate and transmit at least 40% of prescriptions electronically
- implement systems to protect privacy and security of patient data
- provide patients with sum-ups of their office visit within 3 days
- send reminders to patients for preventive and follow-up care
- provide more than 10% of patients with electronic access to their health information (test results, etc.)

So, the next time you’re in your doctor’s office, you might ask him or her about their medical record keeping and how far along they are in implementing the  HITECH imperatives.

In the meantime, check this space for Part 2:  Electronic Medical Records Concerns and Part 3: Protecting Your Medical Records.

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