Stimulus prescription is electronic medical records for all; Southeast Missouri providers in favor of switch

By 2014, each person in the United States is supposed to have an electronic medical record, according to the American Recovery and Reinvestment Act. The law attempts to improve the health-care system by using $34 billion to spur more health-care professionals to use electronic medical records.

Dr. Robb Hicks, owner of Immediate HealthCare Inc. in Cape Girardeau, said he's "not a fan" of President Obama but praised the stimulus plan's financial incentives for converting records. Still, he and other medical professionals said the lack of EMR standards presents a big hurdle in the federal five-year goal.

When Hicks opened a Perryville, Mo., office one year ago this week, he required electronic medical records. Now, he's converting paper records at his 14-year-old Cape Girardeau practice.

"It's the future," he said.

The federal incentive will increase Medicare and Medicaid payments to those with electronic medical records starting in 2011 and continuing for five years, while decreasing payments to those still using paper records. The federal incentive payments are linked to what the stimulus plan calls "meaningful use" of electronic medical records, a term not yet fully defined by the government.

Hicks said electronic medical records improve the quality of patient care, saving time and money, reducing errors, allowing valuable cross-checks on medications and reducing insurance payment times because errors on bills are spotted more quickly.

His reasons were echoed by other health professionals in Cape Girardeau County.

Laurie Davis, business manager for the Brain and NeuroSpine Clinic of Missouri in the Southeast Medical Plaza Suite, worked hundreds of hours with a team of 10 to help her office make the switch Nov. 4.

"We took every paper process and changed it, from check-in to the doctor-patient interaction to check-out and billing. Everything had to be rethought and reworked to a paperless process," she said. "We scanned in everyone's charts and had to make sure those were 100 percent completely accurate."

Though the preparation was painful, the transition was not, she said, and today "we are as paperless as possible, able to electronically grab lab results and issue prescriptions."

Davis said she remains concerned about privacy and the opposing requirements of access and security. She said her office still accepts paper records but looks forward to the day when all medical records are electronic.

Jay McGuire, Southeast Missouri Hospital information systems director, said electronic records reduce preventable medical errors. Over the last 20 years, he's seen the hospital's technology move from one server connected with 30 computers to a network of more than 75 servers, nearly 2,000 desktop or laptop computers. Today, 80 percent of a patient's medical record is electronic, he said, containing doctor's notes, lab results and digital images, among other information.

He's unsure of how the stimulus plan incentive payments will work because "the government has not defined how they will grade on 'meaningful use,' so there's a 'gotcha' there," he said.

McGuire and Diane Gammon, director of information systems at Saint Francis Medical Center, agreed that the biggest challenge to using electronic medical records is the lack of standards for a record itself. Right now, either hospital could conceivably put all of a patient's record on a portable computer drive the size of a thumb -- but a doctor's office or lab computer may not be able to access the information because so many different software products are being used.

"There is also a lot of work to change the culture of health-care providers who want to be able to offer the human touch, which computers often appear to take away," Gammon said.

Dr. R. Daniel Bieser, of the three-physician family practice Mount Auburn Medical Group in Cape Girardeau, said electronic medical records that can be accessed through private online networks help reduce some fraud.

"Every now and then a patient taking a controlled substance will call and ask for a refill and when you check, you can see they just got a refill a few days ago," he said.

Bieser's office converted all its files three years ago, eliminating the cost of retrieving a paper medical chart by replacing it with a click of a computer key.

He said investing in a computer system and software to hold patient records, insurance and billing information reduced the amount of outstanding insurance payments to 5 percent of what it was three years ago and the wait time for payments from more than three months to a few weeks or less. His practice spent about $100,000 to make the switch. In the first year, overhead costs dropped by $80,000, he said.

"No medical record is perfect," Bieser said, but he won't resume using the paper medical chart.

pmcnichol@semissourian.com

388-3646

Pertinent addresses:

150 S. Mt Auburn, STE 342, Cape Girardeau, MO

702 North Kingshighway Street; Cape Girardeau, MO

1508 Edgemont Blvd., Perryville, MO

211 Saint Francis Drive, Cape Girardeau, MO

1701 Lacey St. Cape Girardeau, MO