News Column

Some Doctors Find Switch to Electronic Medical Records Painful

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Phil Talbert took the plunge and bought an electronic medical record system for his small medical practice in Shelby, N.C., in 2010, assuming the pricey computer program would last years, perhaps a career.

Then a month ago, just as Talbert was getting comfortable using the system and appreciating its potential, the physician's assistant got a jolt: The service, called MyWay, was being discontinued. The technology, which doesn't work on smartphones and tablets, is already obsolete.

MyWay, in use by more than 4,000 doctors nationwide, had cost up to $30,000 per doctor to install, or about $600 a month per physician as a subscription service.

"We bought what we bought thinking it was a stable company and it was their newest package," Talbert said. "You spend all this time transitioning to a program, and they come back and say, 'Sorry, guys, we're not going to do this after Jan. 1.' "

The scenario is playing out throughout the nation at a critical time when electronic medical records are no longer optional for doctors and their patients.

The service cancellation by Chicago-based Allscripts is believed to be the first instance of a major vendor of electronic medical records pulling the plug on an electronic medical record system.

In an industry crowded with hundreds of such vendors offering more than 1,000 electronic medical records programs, Talbert's situation is expected to repeat itself across the country as bigger companies gobble up smaller ones and software programs become redundant and obsolete.

The major driver for a wholesale changeover to a new generation of electronic medical records is the Obama administration. As part of the president's move to cut health care costs and improve medical service, the federal government is offering as much as $22.5 billion in incentives for adopting computerized patient records - up to $63,750 per doctor - and also planning to ding doctors who don't use electronic systems for their Medicare patients with penalties up to 5 percent. Additionally, hospitals could receive several million dollars a year for meeting federal Medicare performance targets, and face penalties for noncompliance.

Sprawling corporate health systems that make the switch will spend hundreds of millions of dollars in the next several years replacing electronic medical networks at doctors' offices and training several thousand physicians and nurses on the new systems. But most doctors, those not affiliated with giant health networks, will be shopping on their own for electronic systems. They will bill fewer patients and work longer hours for several months until they attain competence. Some will be updating medical practices that still rely on the ancient system of paper records stored in file folders.

Even among existing systems, not all are yet fully interconnected with each other, requiring receptionists to make phone calls to order lab work, or to fax in prescriptions.

"Overall, it's better than using paper records, but I don't think anyone is 100 percent happy with it," said Terry Brenneman, a Raleigh, N.C., pediatrician.

The shift, however, is inevitable and embraced by a growing cadre of doctors, who swear by the technology and say patients receive better care from programs that flag dangerous drug interactions, send prompts and reminders, sort patient data and plot charts into meaningful patterns.

"It's in your face for safety," said Charles Cooperberg, a Durham, N.C., nephrologist who uses a program called Allscripts Professional and whose 12-person practice netted $18,000 per doctor in federal incentives in 2011. "Multiple people can have the chart up at the same time. It doesn't really matter. Everything's everywhere."

Some health systems have been using a patchwork of electronic records for years, adding so many systems over time that they now have several hundred separate programs that have to be cobbled together with patches and interfaces.

Raleigh-based WakeMed Health & Hospitals, with a network of 250 doctors, uses 130 systems of bedeviling complexity. When the WakeMed system made an internal change, reclassifying NICU from Neurological Intensive Care to Neo-Natal Intensive Care, the new classification required a month and a half of reprogramming, debugging and testing.

"If something that simple takes six weeks, we came to a conclusion that we had to make a change to a single system," said Denton Arledge, WakeMed's chief information officer.

The health system expects to spend more than $100 million over five years on new software and implementation. For its trouble, the health care company is also counting on federal incentives of $15 million to $18 million.

Talbert is dreading the change he'll have to make. He said his practice had to cut its workload in half to learn how to use the MyWay system sold by Allscripts.

When Allscripts said Oct. 5 that it would discontinue MyWay, competitor Aprima announced that Allscripts was "abandoning" its customers. Texas-based Aprima has since retracted that characterization but says in its statements that it is "rescuing" MyWay users. Aprima has offered to give MyWay doctors an $8,500 software license for free for switching to Aprima's electronic medical records system.

Allscripts is offering to upgrade Talbert and other doctors from MyWay to a different Allscripts software program, called Professional, at no extra cost. "Ease of use was really critical to our decision here," Allscripts President Lee Shapiro said of the MyWay phase-out.

The company says 180,000 doctors use its electronic records software, about a third of the nation's practicing physicians, according to Shapiro.

Cooperberg, the kidney specialist, said computerized patient records are essential in his specialty, where patients sometimes use a dozen drugs and have multiple illnesses that must be monitored carefully.

"No one could read my writing - I couldn't read my own writing," Cooperberg said of his scrawled prescriptions, a common complaint in the medical profession. "I could never go back to paper."

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WHAT'S BEHIND THE PUSH FOR ELECTRONIC MEDICAL RECORDS

Electronic medical records, a major part of the Obama administration's strategy to cut medical costs, are driving a massive technology shift in the health care field.

The American Recovery and Reinvestment Act of 2009, commonly known as the federal stimulus bill, includes bonuses for doctors and hospitals that achieve "meaningful use" of electronic records with Medicare and Medicaid patients. Failure to meet the federal goals with Medicare patients triggers penalties.

For doctors, the maximum federal incentive for electronic records is $44,000 under Medicare and $63,750 under Medicaid. Failure to use achieve "meaningful use" targets triggers penalties in 2015. The penalties start with a 1 percent reimbursement reduction in the first year, and increase to 5 percent over time.

The Medicare incentive is available to dentists, podiatrists, osteopaths, optometrists and chiropractors. The Medicaid incentive is available to nurse practitioners, nurse midwives, physician assistants and other types of medical providers.

Under the "meaningful use" standard, the majority of prescriptions, diagnoses and other procedures must be processed and stored electronically.

Hospitals could receive incentives worth several million dollars. The hospital incentives are based on complex formulas, starting with a base minimum payment of $2 million a year that is adjusted on a range of factors.

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