NWAnews.com :: Northwest Arkansas' News Source
Arkansas in forefront of medical tech data
BY BRIAN BASKIN
Posted on Sunday, December 5, 2004
URL: http://www.nwanews.com/story/adg/101011
Dr. Randy Russell spent $90,000 over six exhausting months to convert the paper filing system at his Lake Village Clinic to EMR (electronic medical records). Three patients into the new paperless order, Russell knew he had made the right decision.
Although the woman in his exam room had been his patient for 12 years, Russell hadn’t known that two of her relatives had been diagnosed with colon cancer. But when her medical history was converted to a new electronic record, her file flagged her as having a high cancer risk.
The patient tested negative. But she will now receive automatic reminders to visit Russell for follow-up exams. The same software can check new prescriptions against old ones for potentially dangerous combinations, and provide her — and any future doctor at any connected facility — with an instantly accessible and searchable record of past treatment. "I don’t write any prescriptions," said Russell, whose southeast Arkansas clinic went electronic in October. "I hit a button for pharmacy, it faxes it, and it’s there waiting when [the patient] gets to the drugstore."
President Bush promised in April that a majority of Americans would have access to electronic medical records within 10 years, causing some physicians to declare 2004 the "year of the EMR."
But physicians and policy wonks spent much of "EMR’s" big year trying to understand why a promising and heavily promoted technology is still billions of dollars and several years away from catching on.
The biggest hurdle is money. Not every provider is ready to gamble $100,000 or more on a technology he had just heard about.
Help might be on the way. Arkansas, with an early jump on federal assistance and a growing base of wired docs, is first in the electronic medical records line. "You might think Arkansas is a backwoods," said Dr. Dwight Williams, an early adopter of electronic medical records at his Paragould clinic in 1996 who now advises other clinics thinking about converting. "But we’ve been pretty progressive."
The technology has yet to penetrate beyond the largest and wealthiest providers, however.
Many of the state’s largest hospitals, including Baptist Health and the University of Arkansas for Medical Sciences in Little Rock, as well as Washington Regional Medical Center in Fayetteville, rely heavily on electronic medical records or plan to upgrade soon. But few or none of the state’s dozens of rural and critical-access hospitals uses the technology, said Paul Cunningham, vice president of the Arkansas Hospital Association.
Small private practices similarly have been shut out.
Russell works with three other doctors and a surgeon. His clinic will pay $1,700 per month for technical support and software upgrades in addition to the startup expenses. Russell estimated he lost 200 hours researching and overseeing the installation, and his practice saw fewer patients as staff got used to the technology. "If I were a solo doctor, I don’t think I would have spent that much money to do this," Russell said.
Nancy Archer, quality improvement director for the Arkansas Foundation for Medical Care, said the cost is a roadblock for electronic medical records in a state where the typical practice has one or two physicians. The foundation is helping doctors convert their practices to electronic medical records. Electronic medical record boosters say the system quickly pays for itself. Russell said he expects to recoup the startup costs in four years, as the system eliminates the need for transcriptionists, multiple fax lines and mounds of office supplies. Patient visits entered into a computer are more efficiently coded for insurers, resulting in higher reimbursement rates. For Russell, the death of paper was worth it. "Paper is how medical records were documented 2,000 years ago," he said. "Whatever time we have to spend with paper takes away from what we spend with people." The electronic records are usually kept on a server in the provider’s offices, backed up by an encrypted copy on the software company’s servers.
STICKER SHOCK Russell was on his own when he started looking into electronic medical records in March, relying mostly on word-of-mouth and information supplied by the electronic medical records industry to sort through more than 300 software vendors. Today, physicians considering the switch to electronic medical records can turn to the Arkansas Foundation for Medical Care for much of the legwork. A federally funded pilot program is using the quality-improvement organization as a prototype for a future network of regional groups that assist small health-care providers in adopting electronic medical records. More than 100 physicians’ offices have contacted the foundation about a free assessment to determine what kind of electronic medical records software would make the best fit, Archer said. Two offices are up and running thanks to help from the pilot program. But industry surveys have found most providers say funding is what they really need, and that has yet to trickle down. "For us just to start up it’s about $150,000," said Frank Wise, administrator of the 25-bed Fulton County Hospital in Salem. "Where would I get that? There might be something else I needed worse, if I had it." Wise said it could take eight years or more for his hospital to recoup an investment in an electronic medical records system — too long for a struggling rural hospital to be in the red.
Bush’s announced goal of more than half of providers using electronic medical records, all hooked into a national records network by 2014 — will cost $30 billion to $100 billion, said Dr. David Brailer, appointed by Bush in May to be national health information technology coordinator.
Most incentives will be tied to performance, Brailer said, rewarding practices that adopt electronic medical records and improving quality of care as a result. The first of these incentives will be rolled out Jan. 1 by the federal Center for Medicare and Medicaid Services.
If achieved, an electronic medical records network would, for example, allow a physician to review a patient’s chart while a specialist simultaneously analyzed the patient’s lab results, Brailer said.
Early results are mixed. Archer praised the government’s commitment to promoting electronic medical records systems. But a request by Brailer’s office for $50 million to promote health information technology was recently cut by Congress from a federal spending bill.
Some consumer advocates contend that electronic medical records’ promise of a freer flow of information could come at the cost of privacy.
New patient privacy laws make it possible for doctors to share information about their patients with other caregivers for treatment, payment or other purposes in the name of streamlining health care, said Sue Blevins, president of the Institute for Health Freedom, a Washingtonbased patient-rights organization.
Combined with a nationwide network, the easing of patientprivacy laws could become even more dangerous, she said. "Electronic just means [records] can be shared faster and easier," Blevins said. "It’s simplifying the ability to exchange information with a lack of consent."
Providers who already have converted to electronic medical records deny the technology has the potential to violate patient privacy.
The same patient-confidentiality laws apply to electronic and paper records, said David House, chief information officer for Baptist Health, which began using electronic medical records in 1998. Federal law also mandates that patient information transmitted over the Internet be encrypted, minimizing the risk of theft, he said. "If it’s done correctly, I don’t see any threats," he said.
MARKET FORCES The best way to guarantee widespread use of electronic medical records is for the software companies to lower their prices, said David Wroten, vice president of the Arkansas Medical Society, a professional organization for physicians. "You can buy a software package that protects your computer from viruses and everything else for $20 or $25. But something that generates medical records costs several thousand dollars?" Wroten said. "Physicians are going to have to really see an economical and efficiency provision before they’re going to spend money on something like that." Prices have dropped since the technology first became available in the mid-1990s. Williams of the Paragould Health Clinic said he paid $240,000 for new computers and software in 1996. Russell’s Lake Village clinic, only slightly smaller than Williams’, paid $90,000 to convert eight years later. Some firms are also introducing "doc in a box" systems designed for easier installation in smaller practices, as well as other bare-bones or leased systems, Williams said. But yet more options could cause more problems than they solve, Wroten said. "One of the problems with growth in the technology has been, and probably will continue to be, uniformity," he said. Not every brand of electronic medical records software is compatible with physicians ’ billing and scheduling programs, he said. Also, some doctors are unwilling to be among the first to take the plunge because use of one of the electronic system’s most attractive features — the ability to instantly send records to other providers — requires that everyone has compatible technology, Wroten said. Brailer, the national coordinator, said federal incentives will be designed to convince a number of practices to adopt electronic medical records so the rest will see the technology as an inevitability and follow suit. "The question becomes, when do we get to the tipping point," Brailer said. "Federal policy doesn’t have to... drive this to 90 percent. If it drives it to 40 [percent] or 50 percent, the market will take over and get it the rest of the way."
Brailer said Arkansas Blue Cross and Blue Shield, the state’s largest health-care provider, had the most advanced technology in the Blue Cross network, helping spur growth of electronic medical records systems in the state.
The final, and unwinnable front might be with the older generations of doctors, set in their ways and planning to retire before they would earn back their investment in an electronic medical records system, Williams said.
Although electronic medical records software vendors often promise that the technology makes a doctor’s job easier without significantly changing it, the switch can be jarring for someone with decades of medical experience, said Williams, who has maintained his Paragould practice for 21 years. "There’s a big fear of the machines taking over," he said. "The key is to consider a computer a tool just like your stethoscope."
For more information on how to fax enable your electronic medical records, contact SNAPS. For information on Fax Cards for your software system, contact Brooktrout FAx Boards.
BY BRIAN BASKIN
Posted on Sunday, December 5, 2004
URL: http://www.nwanews.com/story/adg/101011
Dr. Randy Russell spent $90,000 over six exhausting months to convert the paper filing system at his Lake Village Clinic to EMR (electronic medical records). Three patients into the new paperless order, Russell knew he had made the right decision.
Although the woman in his exam room had been his patient for 12 years, Russell hadn’t known that two of her relatives had been diagnosed with colon cancer. But when her medical history was converted to a new electronic record, her file flagged her as having a high cancer risk.
The patient tested negative. But she will now receive automatic reminders to visit Russell for follow-up exams. The same software can check new prescriptions against old ones for potentially dangerous combinations, and provide her — and any future doctor at any connected facility — with an instantly accessible and searchable record of past treatment. "I don’t write any prescriptions," said Russell, whose southeast Arkansas clinic went electronic in October. "I hit a button for pharmacy, it faxes it, and it’s there waiting when [the patient] gets to the drugstore."
President Bush promised in April that a majority of Americans would have access to electronic medical records within 10 years, causing some physicians to declare 2004 the "year of the EMR."
But physicians and policy wonks spent much of "EMR’s" big year trying to understand why a promising and heavily promoted technology is still billions of dollars and several years away from catching on.
The biggest hurdle is money. Not every provider is ready to gamble $100,000 or more on a technology he had just heard about.
Help might be on the way. Arkansas, with an early jump on federal assistance and a growing base of wired docs, is first in the electronic medical records line. "You might think Arkansas is a backwoods," said Dr. Dwight Williams, an early adopter of electronic medical records at his Paragould clinic in 1996 who now advises other clinics thinking about converting. "But we’ve been pretty progressive."
The technology has yet to penetrate beyond the largest and wealthiest providers, however.
Many of the state’s largest hospitals, including Baptist Health and the University of Arkansas for Medical Sciences in Little Rock, as well as Washington Regional Medical Center in Fayetteville, rely heavily on electronic medical records or plan to upgrade soon. But few or none of the state’s dozens of rural and critical-access hospitals uses the technology, said Paul Cunningham, vice president of the Arkansas Hospital Association.
Small private practices similarly have been shut out.
Russell works with three other doctors and a surgeon. His clinic will pay $1,700 per month for technical support and software upgrades in addition to the startup expenses. Russell estimated he lost 200 hours researching and overseeing the installation, and his practice saw fewer patients as staff got used to the technology. "If I were a solo doctor, I don’t think I would have spent that much money to do this," Russell said.
Nancy Archer, quality improvement director for the Arkansas Foundation for Medical Care, said the cost is a roadblock for electronic medical records in a state where the typical practice has one or two physicians. The foundation is helping doctors convert their practices to electronic medical records. Electronic medical record boosters say the system quickly pays for itself. Russell said he expects to recoup the startup costs in four years, as the system eliminates the need for transcriptionists, multiple fax lines and mounds of office supplies. Patient visits entered into a computer are more efficiently coded for insurers, resulting in higher reimbursement rates. For Russell, the death of paper was worth it. "Paper is how medical records were documented 2,000 years ago," he said. "Whatever time we have to spend with paper takes away from what we spend with people." The electronic records are usually kept on a server in the provider’s offices, backed up by an encrypted copy on the software company’s servers.
STICKER SHOCK Russell was on his own when he started looking into electronic medical records in March, relying mostly on word-of-mouth and information supplied by the electronic medical records industry to sort through more than 300 software vendors. Today, physicians considering the switch to electronic medical records can turn to the Arkansas Foundation for Medical Care for much of the legwork. A federally funded pilot program is using the quality-improvement organization as a prototype for a future network of regional groups that assist small health-care providers in adopting electronic medical records. More than 100 physicians’ offices have contacted the foundation about a free assessment to determine what kind of electronic medical records software would make the best fit, Archer said. Two offices are up and running thanks to help from the pilot program. But industry surveys have found most providers say funding is what they really need, and that has yet to trickle down. "For us just to start up it’s about $150,000," said Frank Wise, administrator of the 25-bed Fulton County Hospital in Salem. "Where would I get that? There might be something else I needed worse, if I had it." Wise said it could take eight years or more for his hospital to recoup an investment in an electronic medical records system — too long for a struggling rural hospital to be in the red.
Bush’s announced goal of more than half of providers using electronic medical records, all hooked into a national records network by 2014 — will cost $30 billion to $100 billion, said Dr. David Brailer, appointed by Bush in May to be national health information technology coordinator.
Most incentives will be tied to performance, Brailer said, rewarding practices that adopt electronic medical records and improving quality of care as a result. The first of these incentives will be rolled out Jan. 1 by the federal Center for Medicare and Medicaid Services.
If achieved, an electronic medical records network would, for example, allow a physician to review a patient’s chart while a specialist simultaneously analyzed the patient’s lab results, Brailer said.
Early results are mixed. Archer praised the government’s commitment to promoting electronic medical records systems. But a request by Brailer’s office for $50 million to promote health information technology was recently cut by Congress from a federal spending bill.
Some consumer advocates contend that electronic medical records’ promise of a freer flow of information could come at the cost of privacy.
New patient privacy laws make it possible for doctors to share information about their patients with other caregivers for treatment, payment or other purposes in the name of streamlining health care, said Sue Blevins, president of the Institute for Health Freedom, a Washingtonbased patient-rights organization.
Combined with a nationwide network, the easing of patientprivacy laws could become even more dangerous, she said. "Electronic just means [records] can be shared faster and easier," Blevins said. "It’s simplifying the ability to exchange information with a lack of consent."
Providers who already have converted to electronic medical records deny the technology has the potential to violate patient privacy.
The same patient-confidentiality laws apply to electronic and paper records, said David House, chief information officer for Baptist Health, which began using electronic medical records in 1998. Federal law also mandates that patient information transmitted over the Internet be encrypted, minimizing the risk of theft, he said. "If it’s done correctly, I don’t see any threats," he said.
MARKET FORCES The best way to guarantee widespread use of electronic medical records is for the software companies to lower their prices, said David Wroten, vice president of the Arkansas Medical Society, a professional organization for physicians. "You can buy a software package that protects your computer from viruses and everything else for $20 or $25. But something that generates medical records costs several thousand dollars?" Wroten said. "Physicians are going to have to really see an economical and efficiency provision before they’re going to spend money on something like that." Prices have dropped since the technology first became available in the mid-1990s. Williams of the Paragould Health Clinic said he paid $240,000 for new computers and software in 1996. Russell’s Lake Village clinic, only slightly smaller than Williams’, paid $90,000 to convert eight years later. Some firms are also introducing "doc in a box" systems designed for easier installation in smaller practices, as well as other bare-bones or leased systems, Williams said. But yet more options could cause more problems than they solve, Wroten said. "One of the problems with growth in the technology has been, and probably will continue to be, uniformity," he said. Not every brand of electronic medical records software is compatible with physicians ’ billing and scheduling programs, he said. Also, some doctors are unwilling to be among the first to take the plunge because use of one of the electronic system’s most attractive features — the ability to instantly send records to other providers — requires that everyone has compatible technology, Wroten said. Brailer, the national coordinator, said federal incentives will be designed to convince a number of practices to adopt electronic medical records so the rest will see the technology as an inevitability and follow suit. "The question becomes, when do we get to the tipping point," Brailer said. "Federal policy doesn’t have to... drive this to 90 percent. If it drives it to 40 [percent] or 50 percent, the market will take over and get it the rest of the way."
Brailer said Arkansas Blue Cross and Blue Shield, the state’s largest health-care provider, had the most advanced technology in the Blue Cross network, helping spur growth of electronic medical records systems in the state.
The final, and unwinnable front might be with the older generations of doctors, set in their ways and planning to retire before they would earn back their investment in an electronic medical records system, Williams said.
Although electronic medical records software vendors often promise that the technology makes a doctor’s job easier without significantly changing it, the switch can be jarring for someone with decades of medical experience, said Williams, who has maintained his Paragould practice for 21 years. "There’s a big fear of the machines taking over," he said. "The key is to consider a computer a tool just like your stethoscope."
For more information on how to fax enable your electronic medical records, contact SNAPS. For information on Fax Cards for your software system, contact Brooktrout FAx Boards.
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