The perks and problems of switching over to electronic health records
In 2000, when Dr. James Westcott and other Chico physicians came together to form the medical group Mission Ranch Primary Care, keeping track of patients’ progress was pretty much a pen-and-paper affair. Only a few firms and practices had adopted what’s now known as electronic health records (EHRs) or electronic medical records (EMRs). Everyone else, including Westcott and his partners, maintained old-fashioned folders as their charts.
Times have changed. According to a recent survey by the University of California, San Francisco, 71 percent of California physicians have adopted electronic records.
Of course, this means that nearly three in 10 have not. Moreover, UCSF found that only 30 percent of those with EHRs have software that meets the “meaningful use” standard set by the federal government as part of the Patient Protection and Affordable Care Act.
Those physicians—as well as hospitals—who don’t achieve the required level of functionality by 2015 face reduced payments from Medicare. That stick, along with the carrot of government incentives, has spurred the transfer from paper to computer charts.
Mission Ranch, it turns out, was ahead of the curve. Westcott said his group began its conversion in 2004, using the program from a small company called eClinicalWorks. Since then, eClinicalWorks has grown into a major provider, while other firms dropped out of the market.
“In a lot of ways, we’re really lucky,” Westcott said in a phone interview last week.
Mission Ranch is nearly ready to apply for meaningful-use designation—demonstrating its system can perform a standardized set of tasks that includes compatibility with other meaningful-use systems. When certified, the practice will receive money from the government to help offset the expense of conversion.
Westcott extols the virtues of electronic records. Among the many, he said, “Messaging makes it really easy to communicate notes to the nurse, front office or billing. Patients call, and you can look up their chart quickly. We don’t have information in different parts of the office, and several people can look at the chart at the same time.
“We’d never go back to that [old way, with paper charts].”
Dr. Craig Corp, a Chico pediatrician with North Valley Pediatric Associates, is a new adopter of EHR technology. Corp’s practice switched over a year ago, and he describes the process as “a long process with a steep learning curve.”
The resources involved include not just money, but also manpower.
“We have had to customize it to fit our practice, help stamp out glitches and get everyone used to using it for all aspects of our practice: scheduling, registration, charting, billing, vaccine entry and tracking, phone notes, labs, outside documents, etc.,” he said by email. “It has cost us quite a bit, both in the purchase of the equipment and software to run it, as well as extra staffing to do the arduous amounts of scanning of all of our old paper records as well as all new paper documents that come into the office into the EHR.
“We have gotten some reimbursement from the government that defrays a fair amount of our overall cost, but not all of it by any means.”
Nonetheless, he understands why the government made EHR conversion—and meaningful use—a mandate.
“It is very important that physicians and hospitals be able to share and access records as needed,” Corp said, “so I do think it is important that the various systems be able to communicate. That does add expense to them, but in the long run it will be of great benefit. For example, if a patient is in the [emergency room] unconscious, it would be great if the ER physician could have access to their basic medical history, medication list, allergies, etc.
“We have it set up with one of the local labs so that the results of our patients’ labs go immediately and seamlessly into their electronic record, which helps with tracking if they have been done and speeds our getting the results.”
Similarly, Mission Ranch Primary Care recently upgraded its software to include a secure online portal where patients can view their test results and communicate with their physician.
Another Chico hub for primary care, Argyll Medical Group, adopted electronic records in 2001 and last year switched providers to eClinicalWorks.
“We were unusual in being a start-up [practice adopting EHR],” said Dr. Roy Bishop, Argyll’s CEO, “so only I had paper records; the other doctors started fresh practices with electronic records and had no legacy of paper records.
“With my own ones, I used the paper records in parallel for six months. After that I hardly needed to refer to them again.”
For years, Argyll has used “ePrescribing”—transmitting prescriptions to pharmacies electronically, rather than via hand-written notes on paper pads. That function is among the 15 required to achieve meaningful use—and receive the “HITECH” incentive of $48,000 per doctor over four years.
Like Westcott and Corp, Bishop isn’t surprised that EHRs haven’t been adopted universally.
“In the past this [resistance] was due to cost,” he explained in an email. “For a long time doctors felt aggrieved that they were expected to pay for electronic records, and the benefits mostly flowed to others. At the same time private and government payers were cutting our reimbursements, why would you invest in something when your revenue is going down and there was no proof that the new technology would improve the bottom line?
“Since the government started the HITECH program, there really is no reason not to adopt a system—the holdouts are mostly doing so due to fear of change.”
Corp and Westcott also see a generational bias. As Corp put it, “there are many physicians who do not like computers or are not comfortable with them, especially older physicians, who will likely not change over. Some physicians who are near retirement see it as an expense that they will not make up in their remaining practice years.”
That hasn’t been a problem at Mission Ranch. Westcott says all his peers have taken to the EHR, and each new physician who’s joined the practice has gotten the hang of the system within weeks or months.
“In our case, it wasn’t so hard to do what the government wanted us to do,” Westcott said. “All the doctors are doing things for us to qualify.”