Health Care IT Cautiously Advances

Technology in the 21st century is typically a fast-moving phenomenon. Take cellular phones, for instance. The first iPhone was unveiled in 2007 – a mere six years ago. Today, the iPhone and its smartphone competitors are ubiquitous and even necessary for many people. Television is another example.

The first high definition broadcast of the Super Bowl didn’t happen until the year 2000. Now, a mere 13 years later, HD is the norm, and televisions are expected to come packaged with 3D technology, web browsers and apps, and even motion sensors.

Generally, when modern technology is developed, it takes hold quickly. Which is why, for the lay person, the slow spread of electronic health records (EHRs) in hospitals and doctors’ offices nationwide is somewhat puzzling.

There’s little doubt that EHRs are a big part of the future of modern medicine. Studies show that EHRs improve patient care quality, accuracy of diagnoses, care coordination and practice efficiency when compared with paper charts. With an EHR, a doctor or a member of a doctor’s staff can easily spot trends in a patient’s health and quickly share information with other doctors in an emergency. All of this saves money and provides a better health care experience.

However, EHRs have only started becoming commonplace over the past few years. It’s not the fault of technology. Modern computers and network systems have been capable of handling EHRs for years. The problem seems to be simply getting health care providers to implement the system, whether because of the cost, time constraints or computer illiteracy. And these problems have led to some headaches.

“There’s nobody that helps you figure out how it will work in your office,” says Janie Pillsbury, office manager for Dr. Richard Pillsbury in El Dorado.

“I don’t care how much support you have. We had to figure out how we were going to manage the computers and the patients. It was horrible. Everybody was miserable, everybody was frustrated. There may be a whole lot more support now, but nobody can show you how it’s going to work in your office until you jump in.”

To help with some of the problems, the federal government is providing financial incentives for practices to begin implementing EHRs instead of using paper charts. The Centers for Medicare and Medicaid Services (CMS) has started a program to reward what it calls “meaningful use” of EHRs. This includes using EHRs to track patient information, report quality measures and prescribe medications. There are three stages of meaningful use, and if practices meet each stage on time, they are rewarded. For a health care provider to qualify for the program, their patient volume must be at least 30 percent Medicaid patients (20 percent for pediatricians).

“The government is giving $21,250 in the first year and $8,500 for the next five years if they (providers) meet all of the requirements. And they can put it in their personal account or they can put it in their business,” says Edward Morin, program specialist with the Arkansas Department of Human Services’ Division of Medical Services.

But some providers say that money isn’t nearly enough. Pillsbury says she had to call in contractors to build places for computers in her older office building. She also had to hire two new workers to help import thousands of charts into the new system and to help oversee EHR maintenance.

“The reimbursement is supposed to help you defray the cost, but there’s no way, it can’t begin to defray the cost,” says Pillsbury. “Now, we have a great system, there is no chart to lose, you don’t have to find a chart on somebody’s desk. All those things are great about EHRs. But implementation is difficult.”

In order to track the progress of Arkansas hospitals and doctors’ offices, CMS contracted with Hewlett-Packard. HP handles all meaningful use reporting and decides whether practices are meeting the standards from CMS. HP then handles the payments from Medicaid to health care providers.

“HP and ourselves (Arkansas Medicaid) also go ahead and double check their numbers to make sure they do reach the benchmark. And if they don’t reach it, we ask for more information, more details. We’re trying to help everyone get on board,” says Morin.

Helping in the meaningful use effort is HITArkansas, a branch of the Arkansas Foundation for Medical Care. HITArkansas serves as Arkansas’ regional extension center. Regional extension centers in each state work with providers who lack the resources to implement and maintain their EHRs. They operate with funds from the federal government.

“Our role is to help the providers,” says Jennifer Pagan, outreach and marketing coordinator at HITArkansas. “We basically go to hundreds of providers in the state and make sure they have what they need to use their EHRs in a meaningful way.”

Arkansas Medicaid, HP and HITArkansas are now working together to find the doctors and hospitals that take Medicaid patients but aren’t yet signed up for the meaningful use program. CMS says nearly 3,100 hospitals and physician offices in Arkansas have registered their EHRs. However, it is likely that thousands more in the state have begun or completed implementation already, but aren’t receiving federal funds.

“They have until 2016 to register,” says Morin. “So I don’t feel that there’s a need to start pushing people, however, we want everyone to get on board as soon as possible so we can start running with it.”

Morin is pleased so far with the progress Arkansas health care providers are making. As of February 2013, Arkansas hospitals and doctors have received more than $139 million from the meaningful use incentive program. And with more providers registering for the program, that number is likely to rise quickly.

“Given our population, I’d say we’re doing extremely well,” says Morin. “I am on calls constantly with other states, and we compare numbers, and Arkansas is pretty much up there. We got started with implementation very early, and HP has been a great help in getting everything done on time.”

There seems to be little doubt that electronic health records will eventually be the standard in doctors’ offices and hospitals across the country. There remain a number of challenges for health care providers in implementing their EHRs, and the challenges have led to some stress for offices like Pillsbury’s, but for the most part, these providers see the benefit of getting electronic systems in place.

“I would say it today that it was not worth the hours of frustration and arguments and fights, it will never be worth that, it was about a year of my life,” says Pillsbury. “But, I think probably we practice better medicine because we document better. And I think it’s the way of the future. We can log in to the hospital and get records, and everything will eventually be integrated. So I think there’s good and bad.”