March Toward Digital Records

National health care, proposed in a variety of ways advanced by Democrat leaders of the House and Republican leaders of the Senate, has been on hold through August as Congress took its summer recess.
Two leading measures are House Resolution 3200: America’s Affordable Health Choices Act of 2009 and a Senate bill: Affordable Health Choices Act.
HB 3200, sponsored by Michigan Democrat Rep. John Dingell, seeks to expand health care coverage in the U.S. to cover the estimated 40 million uninsured Americans. To do that, a government health care program would be created to compete with private insurance companies.
The Senate proposal, passed through the Senate’s HELP committee, seeks “to make quality affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce.”
Following Labor Day, debate is expected to heat up as the Democrat majority, who can pass health care legislation without any Republican votes, begins a push for universal health care.
The issue is being debated on a number of fronts. One proposal, House Bill 3200, calls for medical records to be digitized.
But the health care industry has been making the transition from paper and film records to 1s and 0s for several years as hospitals and clinics across the country see the benefits of access and saving dollars.
Not that there is a tidal wave of records being digitized — more like a ripple. Industrywide, maybe 15 percent of physicians nationwide are digitizing medical records, said Dan Ramsey, CEO of Utica Park Clinic.
“The adoption rate is slow,” Ramsey said. “A handful of small practices.”
Hospitals are moving in that direction as space availability is an issue, said Mike Reeves, CIO for St. John Medical Center.
“Many hospitals are reluctant to go 100 percent paperless,” Reeves said. “A facility might lease space or go underground, but it could take hours or days to retrieve a record. But, I do not see us going 100 percent paperless in our facility.”
Hospital medical records have been converted to digital format for more than 10 years, said Stanley N. Schwartz, medical director at Warren Clinic and vice president at Saint Francis Health System.
“We began installing electronic medical records in Warren Clinic, the employed physician entity of Saint Francis Health System, in 2008. About one-half of Warren Clinic offices now use electronic medical records (EMR),” Schwartz said. “The remaining offices will have their records online by the second half of 2010.”

Moving Forward
Tulsa hospitals are committed to the process, area executives said.
St. John Medical Center began going paperless eight years ago, said Reeves.
“It has been a huge success,” Reeves said. “We have been very progressive in that respect. In terms of patient safety and outcomes, we feel it is the right thing to do.”
Storage space in hospitals comes at real premium, he said. There is space saving and cost savings.
Hospitals are utilizing electronic bill paying, virtual doctor visits are on the increase and outpatient and ER medical records are easier to retrieve.
The space needed before digitizing records takes a lot of acreage.
At Warren Clinic offices, officials devoted one full room per office to storing paper charts, Schwartz said.
“As we go digital, we expect to reclaim that space as we are able to put our inactive paper charts into long-term offsite storage,” he said.
There are two ways to capture the information in paper charts.
First, charts are scanned to digital format page by page, with the computer files stored on hard drives or CD/DVD discs, Schwartz said.
“This method is not only labor-intensive but also creates a file that is difficult for a physician to use,” he said.
Another method is called “abstraction.”
Important medical facts in the old paper medical record are entered by an abstractor into the EMR. This technique best prepares the EMR for the physician who can then quickly find the information he/she needs for patient care. After the abstraction is done, the paper chart is kept in the office for several months just in case and then it is sent to a secure long-term storage facility.

Transition Costs
Up front costs are the reason organizations do not move faster toward electronic records, said Richard Gomez, IT director for Utica Park Clinic. It can cost $35,000 to $40,000 per medical provider, he said.
Thirty Utica Park providers use the digital system.
“Starting an electronic medical records system in a physician office costs a little more than $30,000 per physician,” Schwartz said.
The front-end cost to get this up and running can run in the hundreds of thousands per doctor,” said Utica Park’s Ramsey. “Then they begin to stabilize over time.”
Utica Park plans to move 140 providers into the digital realm over the next two years. Costs include having a parallel environment of paper and digital system.
“All those paper charts do not just go away,” Ramsey said. “There is a period where both exist and, over time, the physical paper world falls away. Roles change for staff but then drop off as electronic records must by maintained.”
For a medical complex like St. John Medical Center, the investment price tag can run in the tens of million of dollars, Reeves said. Maintaining electronic records is part of an overall $10 to $20 million IT budget.
The cost of an inpatient electronic medical records system costs millions, said Schwartz.
“It is not trivial to be able to afford to do something like this,” Reeves said. “There is the infrastructure. The capital expenditure it takes to pull off something like this is huge.”
There are redundant systems in place to house and maintain data centers. SJMC for example, has data centers across Tulsa to avoid a hardware disaster.
“So, if the Fire Department shuts us down for smoke damage, we have separate records, keeping data which mirrors the data,” Reeves said.

The reality of moving toward an electronic environment is a major cultural change, Ramsey said.
Productively slows down as the staff requires training. Also, the transition requires more effort from the physician as they are required in some cases to perform data entry, keying in patient notes or write prescriptions online.
Maintaining electronics can be a bigger headache than having walls and walls of paper records, executives said.
Records are not maintained a the clinics but at a central site. Record back ups are not maintained in Tulsa or the state, but out of state. A central site must be protected from natural disasters, electrical failure and redundant climate control systems.
“There are several layers of protection,” Ramsey said. Area medical facilities maintain database out of state in Kansas City, Mo., and Nashville, for example. ?

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