Electronic health records surge despite barriers

By Kimberly Ashton

Although Massachusetts has a head start on the national effort to digitize medical records, much work remains to be done before the state can meet President Barack Obama’s goal of having all health documents computerized by 2015.
The path ahead isn’t straightforward, and physicians must pay attention to the potential legal risks involved in using electronic health records (EHRs). A number of technological and financial hurdles stand between the government mandates and getting the nation’s medical system wired.

According to Kristina Barry, a spokeswoman for the state Office of Health and Human Services, 90 percent of private medical practices in Massachusetts are still not using EHRs. It can take years to select a vendor and set up electronic records in a typical medical office.

To meet deadlines and be eligible for incentives, physicians should start preparing now for the complete transition to electronic records, said James Bush, director of practice services at Massachusetts eHealth Collaborative.

“In order to qualify for incentives, providers really need to act now,” Bush said.

Incentive payments for physicians who implement EHR systems are scheduled to begin in 2011 for doctors who have EHRs that meet a “health information standard” and a “meaningful use standard,” neither of which has been defined yet, Bush said.

The Centers for Medicare and Medicaid Services (CMS) will be leading the formal rulemaking process to define “meaningful use standard” under the new law, according to discussions at a federal HIT Policy Committee in mid-June.

Failure to switch to EHRs won’t just result in missing out on funding. As of 2015, adoption of EHRs will be required for physicians to gain hospital licensure. And 2012 is the deadline for computerized physician order entry systems, Bush said.

The federal American Recovery and Reinvestment Act, passed Feb. 17, allocated nearly $20 billion for health information technology across the country.

“We estimate approximately $500 million over five years in [federal] funding” will be given to Massachusetts, said Barry.

States are required to match $1 for every $10 provided in federal EHR implementation grants in 2011, $1 for every $7 in 2012, and $1 for every $3 in federal grants in 2013 and beyond.

In order to make sure the state has funds allocated to match the expected federal funds, the state Legislature in August allotted $25 million per year over the next seven years for adoption of health information technology. The amount was later cut to $15 million, with funding allocated only for one year.

Before the state doles out the money, the state’s nine-member Health Information Technology Council – which was appointed by Gov. Deval Patrick – must first decide how it will be distributed.

Attorney David Szabo, who sits on the council and is a partner at Nutter, McClennen & Fish in Boston, said the council will have control over allocating the state funds, but it’s still unclear what role it might play in doling out the federal money.

The council is now in the process of gathering feedback from health care providers, software engineers and other interested parties, and there is no date set to distribute the funds, according to Szabo.

A costly endeavor

Although most large providers, such as Beth Israel Deaconess Medical Center, have already implemented EHRs, many small medical offices have found it cost-prohibitive.

Dale Magee, former president of the Massachusetts Medical Society, estimated that only 10 percent of small practices use EHRs.

Barry agreed with this figure, and said that two-thirds of hospitals need additional resources to have fully integrated electronic records in place.

“Financial barriers are viewed as having the largest effect on the decisions to implement [electronic records]. The [health] council will be working to alleviate these barriers,” Barry said.

EHR software runs well over $10,000 per doctor, and support can easily cost 15 to 20 percent of that each year, said Magee, whose office has been using EHRs since 2002. Even if a physician’s office has the capital to invest in such software, there is no guarantee that the program won’t be obsolete in a few years, requiring a large, new investment to update it.

On the flip side, politicians often cite cost savings as one of the main reasons to transition from paper to computer.

But Magee is doubtful.

“I think you do better care [with EHRs], but you’re not going to save money,” Magee said.
Szabo agrees that EHRs won’t produce an immediate savings.  “In the short term it might not make the practice more profitable. It might require [doctors] to change business practices, [resulting in] a period of reduced productivity,” he said.

Others, including Obama, claim that electronic records will reduce the cost of health care.

Legal, practical concerns

Doctors should pay attention to the details of the contracts they enter into with EHR software providers, Szabo said.

For one thing, they should determine to what extent the company selling the software will aid in implementing it, he said. Also, they should enter into some sort of agreement concerning IT support.
Physicians must also make sure their EHR systems comply with state and federal privacy rules, Szabo said.

Magee said his records are protected by a firewall and a series of passwords, a system that makes it impossible for outside persons to view the records but also allows him access to them when he is away from his office.

Many of the privacy concerns are based on “fear more than reality,” Magee said. “There is far more harm done in medicine today by health care providers lacking information than by patients’ privacy being violated.”

Barry said that the council is looking into whether addition statutory protections will be necessary to protect patient privacy.

Another concern is that the many programs on the market are not interoperable – which means they don’t allow one office’s electronic records system to communicate and connect seamlessly with other offices’ and hospitals’ systems. And there has yet to emerge one dominant software player.

“The technology is where word processors were in the mid-1980s,” Magee said in terms of compatibility.  “The industry absolutely needs some interoperability standards to be stronger than they are at present.”

He noted that he even finds it difficult to share information with other doctors who are using the same program, and that the IT support for the electronic records platforms tends to be inadequate.

Questions or comments should be directed to the editor at: reni.gertner@mamedicallaw.com