Doctors Going Digital

Dr. Brian Hummel spent the spring researching and interviewing electronic medical-record companies, at the same time keeping up with the busy pace of seeing patients and helping them battle heart disease.

Hummel, one of 10 physicians at Gulfcoast Cardiothoracic and Vascular Surgeons, has heard the arguments that electronic records can provide more efficient health care and allow patients to access their files. The road to going digital, however, is as rocky and difficult as convincing some patients to start exercising and cut out fried foods. Physicians and medical administrators must sort through dozens of software providers and learn how to meet the requirements for federal stimulus funds—up to $44,000 in Medicare reimbursements—that make the investment a little more affordable. Hummel’s group anticipates the expense for its Fort Myers and Naples offices to be about $70,000.

“The most significant challenge is just the overall cost and the complexity,” says James R. Nathan, president and CEO of Lee Memorial Health System. “There’s not a Bill Gates of healthcare information yet. As a result, it’s hard to get one software system to speak to another software system.”

Those aren’t the only complications. Physicians have to figure out what to do with all their charts and records, which are time-intensive to scan, and make sure they don’t violate The Health Insurance Portability and Accountability Act rules about patient confidentiality.

“It’s more complex than we anticipated it would be,” says Hummel, who hoped to have the software selected by this month.

Like other physicians, Hummel is taking a cue from local hospital systems and switching to electronic records. Doctors appreciate being able to view patient information in a consistent format, compare lab results, medications and symptoms, use technology to research diseases and treatments, and analyze how patients in similar age groups or circumstances respond.

“We’re able to deliver higher quality medical care because we have better access to information,” says Dr. James Penuel Jr., a gastroenterologist with Digestive Health Physicians in Fort Myers. “None of us can know everything, but we need to know where to find it, and where to find it quickly. The more complete the information, the better decisions we can make.”

For patients, electronic records also can reduce the hassle of repeatedly having to fill out forms for medical history, insurance information and other details every time they visit a different doctor or hospital, and many can access their information and charts online.

“Some [physicians] are just dipping their toe in, and others have jumped into the deep end,” says Stephen J. Myers, CEO of Naples-based InfiNetwork, which assists practices installing electronic medical records (EMR) and electronic health records (EHR). (He describes EMR as internal while EHR can be accessed by those outside the practice.)

MAINTAINING PRIVACY IN A DITIGAL WORLD

Most physicians are setting up systems with secure remote access to view charts and information from the hospital or home, but connecting electronically with a hospital system or with other practices appears to be in its infancy in Southwest Florida because of privacy concerns. Nathan also has heard that some physicians are fearful that others might steal their patients by accessing their personal information.

“Everybody is afraid of a HIPAA violation. If [we] connect into a hospital system, we don’t have control of that anymore,” Hummel says. “Clearly there’s a lot of lawyers running around looking for work, and I don’t want to be the test case saying we violated HIPAA.”

The catalyst for Lee Memorial’s initial $5 million investment in ambulatory electronic medical records (the Epic system) was a 2007 task force that identified it as the community’s top healthcare need. It expects to spend another $70 million on expanding it system wide.

So many facilities and specialists are involved in providing care for individual patients that the system is fragmented, Nathan says. “National research has shown that there is a tremendous value in the ability to speed up the communication via electronic capabilities. That’s why the feds are willing to invest so heavily, because they believe there will be fewer medical mistakes, faster transfer of information and fewer duplication [of procedures],” he says.

Lee Memorial expects to benefit from some of the $19 billion in stimulus funds set aside to encourage hospitals and health systems to go digital by 2013. EMR has been installed in the emergency departments at Cape Coral Hospital, HealthPark Medical Center, Lee Memorial Hospital and in most of the primary care Lee Physician Group offices. GulfCoast Hospital expects to go live in mid-2011. By 2012, all LMHS hospitals will have the technology, and by 2013, Epic will be installed in all Lee Physician Group and employed specialists’ offices.

“In 10 to 15 years, the conversation we’re having today [about physicians’ concerns] will be ancient history,” Nathan says.

Penuel is among the physicians in discussions with Lee Memorial officials to determine how to link its existing system with Lee Memorial’s. He believes an electronic records system that’s connected to other doctors offices and hospitals is far more valuable than a stand-alone system in a single practice. “We know this is where we need to go in the future, and the community really extends beyond the boundaries of Lee Memorial’s information system,” he says.

Penuel is considering using an option like Epic because of the ability to link with Lee Memorial and because the practice’s existing system likely won’t meet the criteria for stimulus funds.

Physicians realize the government funds won’t cover the entire cost. In addition to the software, expenses include IT infrastructure (Naples-based Neuroscience and Spine Associates has invested in the reliability of fiber optic), equipment such as wireless tablets and computer monitors in exam rooms so patients can see X-rays and MRIs, and maintenance and annual fees. Plus, some offices need more manpower; one of Myers’ clients is using temporary workers to scan thousands of charts.

STEEP LEARNING CURVE

Leaving behind paper charts and dictation can be challenging because sometimes the technology is not as convenient as grabbing a pen and a piece of paper, Myers says.

“In general, people think it’s a good idea. The doctors even think it’s a good idea,” he says. “In practice, it’s been very slow to adopt. It takes the doctors a while to get up to speed on it.”

Some doctors and patients don’t grasp how large an undertaking it is for a physician to make medical records electronic. Doctors believe it can be done with “little thought,” says Arthur Perry, administrator and CEO of Neuroscience and Spine Associates. The practice, which has 12 physicians and 103 employees, spent at least a year deciding on the system and provider, and is in the midst of implementation, which could take eight months or more in their six Southwest Florida locations and separate billing office.

Physicians’ needs are so specialized that they have to help design a program, Perry says. “You can get canned stuff, but then they’ll get mad at it and say it doesn’t meet their needs or the way they like to practice. The doctors have had to invest personal time and effort in it.”

Greg Smith, office manager for orthopedic surgeon Dr. Michael T. Havig, whose Naples office made the transition about three years ago, says crucial training came through online videos and testing a dummy program. Still, some of the procedures were by trial and error. One of the early challenges is learning how to interact with patients differently, because physicians are being asked to enter information while meeting with the patient, taking away eye contact at times.

DELIVERING BETTER CARE

Electronic medical records take the detective work out of finding charts and patient information, and remove room for error, Perry says.

Havig’s office had been spending about seven man-hours a day searching for charts that might have gone home with the doctor or been in use by a nurse. Now, when physicians treat patients at NCH or Physicians’ Regional, they can log into the office’s system (using a secure Internet connection) to access patient information.

“When you go to an EMR, the chart is right there,” Smith says.

Nathan’s family has experienced the benefit of going digital. A family member with a complex illness in California was seeing physicians affiliated with three different health systems and with limited communication, Nathan says. When the physician team was adjusted to include those from one health system with access to the same medical records, it improved timeliness of data, reduced duplication of tests, and improved management of drug interactions, he says.

The portability of medical records is another key benefit, especially for seasonal Southwest Florida patients, who live elsewhere for part of the year.

“In a paper environment, people had their medical records scattered all over the place. That was why when you would go see a doctor or if you went to the Mayo or Cleveland Clinic, they would say, ‘Bring your medical charts with you,’” Myers says. “When it’s in a digital format, now you can keep them together, you can send them electronically in a secure format.”

Nathan says it’s necessary for hospitals to embrace electronic medical records also to recruit much-needed physicians to Southwest Florida. “The doctors coming out of training today, they don’t even want to go somewhere where there’s not an effective medical record system,” he says.

More than 300 physicians on staff at NCH have access to its electronic medical record system, called PowerChart, from their offices and homes. The system, which cost in the tens of millions (an exact figure was not available from NCH) is its biggest investment after buildings, says Dr. Allen S. Weiss, president and CEO of NCH Healthcare Systems. The capabilities include electronically generating prescriptions and discharge instructions, which are used by about half of its physicians, the anesthesiologists and emergency department physicians.

“If [the medical industry doesn’t] go digital, we’re going to be dead,” he says.