Health-care overhaul: Doctors must go digital

, ,
healthcare providers must go digital

Hundreds of thousands of paper sheets bulge from the weathered charts in the medical office of Dr. Tahsina Atiquzzaman.


Patient histories, stress tests and results from colonoscopies are piled in filing cabinets, wall shelves and storage closets in her Kissimmee private practice, where she sees more than 5,000 patients each year.


But the internal-medicine practitioner — and thousands of other doctors — are gearing up to go paperless.


Atiquzzaman is one of about 1,400 Central Florida doctors who will be tossing out paper charts and ushering in digital records as part of the health-care milestones announced last month by the federal government.


The new guidelines require doctors to trade paper and pen for mouse and keyboard. They must use computerized records in a meaningful way: to order prescriptions electronically or check a patient’s symptoms, diagnoses and medication history. Advocates say the so-called “meaningful-use criteria” will not only save lives but time and money.


Attached to the guidelines, which doctors must meet by 2015, are carrots and sticks. Physicians who adopt the criteria before 2015 can earn as much as $64,000 during the next five years for their practice. But doctors who miss the deadline face cuts in how the government reimburses them for Medicaid and Medicare patients.


Orlando Health and Florida Hospital already have checked off several of the 25 milestones and say they are on schedule for the 2015 deadline.


But local experts worry that older primary-care physicians, already in short supply in the U.S., will close their practices rather than buy expensive software and train their staffs in new technology.


Twenty percent to 30 percent of primary-care doctors are now considering early retirement because of the guidelines, estimates John Littell, a family-practice physician in Kissimmee and president of the Osceola County Medical Society. Such doctors already retire as young as 50, he added.


“We don’t want to lose the older doctors, so it’s very important we find ways to reach out to them,” said Jeanette Schreiber, associate dean for special projects at the University of Central Florida College of Medicine. The school received a $7.7 million stimulus grant in April to train physicians and their staffs to use the digital record-keeping programs.


Why electronic records? Health-care experts have estimated the cost of not having electronic records at nearly $78 billion a year. That figure includes the cost of sending lab results between hospitals and outside laboratories, duplicating medical procedures and shuttling paper charts among doctors.


Just cutting out phone calls between doctors and pharmacists would save at least $2 billion each year, according to a 2005 study funded by the Center for Information Technology Leadership, a nonprofit research organization in Boston.


The instant access to information also could save lives. The first day Orlando Health launched its electronic medical records in 2001, an 82-year-old woman was rushed into the ER unconscious after a car accident with no identification except her drivers license. Before starting to treat her, doctors entered her name into the computer system and found she was on the highest dose of blood thinners from an operation for an abdominal aneurysm a week before.


“If we hadn’t had that software, we surely would have killed this woman,” said Becky Cherney, president of the Florida Health Care Coalition in Orlando.


Cherney’s organization has spent the past decade linking local hospitals and doctors to a Central Florida repository of data for millions of patients, the kind of database needed for emergency rooms to quickly access information even if the patient has never been to that hospital. Cherney estimates the database will come online in Central Florida emergency rooms this fall for a one-year pilot study.


The benefits a patient database brings to public health could be enormous, said Alan Spitzer, a neonatal researcher at Pediatrix Medical Group in Sunrise. Keeping track of how many children are injured in accidents, such as pool drownings or head injuries, can alert doctors to troubling trends in real time.


Barriers: Cost, hassle The cost of purchasing and maintaining the software is steep, and health-care providers say stimulus money won’t offset the full cost. Orlando Health estimates the federal incentives might cover only 25 percent of its electronic-records costs, said Rick Schooler, chief information officer for Orlando Health. But small practices could have to pay $25,000 to $40,000 for software, computers and technical support.


The UCF team is trying to secure loans from local businesses and commitments from software vendors to keep startup costs low until reimbursements kick in. The sooner doctors adopt the guidelines, the more money they receive.


Not everyone is on board with the changes.


Some primary-care physicians worry that new requirements for reimbursement — such as filling out a questionnaire about each patient — would take away time that should be spent face to face with the patient.


“Let’s say a patient comes in with diabetes, high blood pressure and asthma,” said John Littell, a family-practice physician in Kissimmee and president of the Osceola County Medical Society. “The government wants to see you’ve done a foot exam, an eye exam, urine tested, et cetera. In the ideal setting, we’re going to do that.


“But the reality is she’s also suffering from depression and anxiety because her husband lost his job and her son is in Iraq. In a 15-minute appointment, I’d want to focus on the underlying anxiety, not justify the reimbursement to the federal government.” Several physicians have voiced concerns over privacy.


“I don’t want any information from my patients to get out that they don’t want out,” said orthopedic surgeon Scott Gordon at a recent Osceola County Medical Society meeting.


To break into a system such as Orlando Health’s, hackers would have to penetrate multiple layers of protection, according to Schooler. Then they would have to know how to log in as a valid user, and then log in to specific applications.


Despite fraud and privacy concerns, area doctors are warming to the idea of electronic records, in part because of incentive money. More than 400 physicians have committed to working with UCF, according to Karen van Caulil, executive director of the UCF initiative.


Tahsina Atiquzzaman says she’ll need the incentive money to hire someone to digitize all of her patient charts, which would fill a small room lined with filing cabinets. She has budgeted $20,000 for new computers and hopes the UCF initiative will save her money on software, which she expects would be another $20,000.


“Cost is the biggest obstacle,” she said. “I’m waiting to see how much this will be.”


What needs to be electronic before 2015? A percentage of certain types of medical records need to be online within the next 5 years.


List of problems, diagnoses and any allergies for at least 80 percent of patients.


An active medication list for at least 80 percent of patients, plus alerts if two drugs don’t interact.


Patient access to test results, problem lists and medication lists within 3 days for 50 percent of office visits.


Chart changes in height, weight and blood pressure for 50 percent of patients.


Prescribe medications and receive lab results digitally at least 40 percent of the time.



SOURCE: Department of Health and Human Services By the numbers: Carrots and sticks Under the new health-care law, doctors will be rewarded — or penalized — for their response to adopting electronic records. Here’s what’s at stake.


$44,000 to $64,000: Incentive for physicians in small practices who adopt guidelines in next 5 years.


$16 million: Incentive Florida Hospital expects to receive from meeting guidelines on time.


$14 million to 15 million: Incentive Orlando Health expects to receive from meeting guidelines on time.


1 percent: How much Medicare reimbursements will drop per year from 2015 to 2020 for doctors who don’t meet guidelines.


45 percent: How many primary-care doctors the University of Central Florida College of Medicine has funding to train to use electronic records.


Marissa Cevallos

[August 10, 2010]

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *