It may take you longer to see a doctor, but you'll get a written summary of what happened at the appointment after you go.
And your physician may electronically track your weight and tobacco use, but the recording of that information — and the admonitions to slim down or quit smoking — could come when all you want is an antibiotic.
The concept of meaningful use of electronic medical records is based on these priorities:
» Improving quality, safety and efficiency,
and reducing health disparities
» Engaging patients and families in their health
» Improving care coordination
» Improving population and public health
» Ensuring adequate privacy and security protection for personal health information
» The federal Centers for Medicare & Medicaid Services grants an incentive payment to eligible professionals or hospitals that can demonstrate that they have engaged in efforts to adopt, implement or upgrade certified electronic health record technology.
» Payments range from $44,000 over five years for the Medicare providers and $63,750 over six years for Medicaid providers.
» Participation in the program is voluntary, but if the eligible professionals or hospitals fail to join by 2015, their Medicare/Medicaid fees will be reduced by 1 percent, escalating to a 3 percent reduction by 2017 and beyond.
Using a combination of incentives and penalties, the federal government is encouraging doctors and hospitals to use electronic medical records in a meaningful way. The push for what's called meaningful use already has started to change the ways doctors provide care.
Some doctors welcome the change and say it benefits their patients. Others say they won't abandon paper records, even though it means they will get smaller Medicare reimbursements.
The push for electronic health records predates the new federal health care law. In 2004, then-President George W. Bush laid out a plan to ensure that most Americans had such records within 10 years. The plan included increased federal funding and the creation of a national health information technology coordinator.
In 2009, the federal stimulus package further boosted federal spending and set up the incentives and penalties meant to spur widespread adoption of the technology among providers.
Physicians in Nebraska and Iowa have been installing electronic recordkeeping systems over the past decade. A third of Nebraska physicians and more than half of Iowa physicians told government researchers that they have installed a system that tracks:
» Patient history and demographics.
» Patient problem lists.
» Physicians' clinical notes.
» Lists of patients' medications and allergies.
Systems also allow computerized orders for prescriptions and the ability to view lab and imaging results electronically. The systems range in price from $3,000 to $15,000 per provider, plus a maintenance fee.
Jessica Quick, office administrator for Colon and Rectal Surgery Inc. in Omaha, said it cost her office, which has five physicians, $150,000 for installation and upgrades of the system, plus $40,000 per year for maintenance.
Hospitals also are installing the systems, but theirs are much more expensive. The Nebraska Medical Center and its partner the Bellevue Medical Center and related clinics, for example, spent $85 million on their system and training. They started using the system in inpatient areas in August.
Alegent Creighton Health says it will cost $138 million to install its system at 11 hospitals and all of its clinics.
Part of the government's checklist for meaningful use requires physicians to record patients' demographic information, such as race, preferred language, ethnicity, tobacco use and body mass index. And that record is made regardless of the purpose of the doctor visit.
Quick said the questions have added about five minutes to patient visits. That means instead of seeing four patients per hour, the doctors are seeing three. That, she said, means patients can't get office visits scheduled as soon as they would like.
Dr. Jennifer Kay sees more positives with the system. Her Council Bluffs family practice is paperless, with scheduling, billing, patient records and all lab orders handled electronically.
Kay takes her laptop computer or iPad into the exam room, where she or an aide enters diagnoses and medications she is prescribing. The office can provide the patient a paper copy or flash drive of that record. Patients also can log into a patient portal on home computers.
“The ability to be very accurate with your recordkeeping is huge,” Kay said.
One of Kay's patients, Bluffs resident Jennifer Mendoza, uses the patient portal to check her medical records and the immunization records of her children. “It's super easy to do,” she said, “and I don't have to call and bother the girls upfront.”
Kay noted that during one recent patient's visit, the electronic system alerted her that a patient needed a follow-up colonoscopy.
“Without my electronic medical record, what clue would I have had?” she said. “A file card somewhere? A chart review later?”
Dr. Paul Nelson, however, says he can grab a patient's paper chart and quickly find when the patient last had a colonoscopy or mammogram and review other key data in the person's medical history.
The Omaha physician, who has been practicing for 37 years, has no plans to convert to electronic records.
“I have flow sheets that go back 20 years,” he said.
If a patient says he doesn't know why he stopped taking a certain medication, Nelson said, “I can go to that date — it takes me 10 seconds to do — and say, 'Yeah, you had this drug interaction.'”
With an electronic system, he said, it would take much longer to scroll through several pages of data to find what he was seeking.
As more health care providers install the systems, information about people's previous test results and exams eventually will be accessible to providers around the country, said Dr. Harris Frankel, a neurologist at the Nebraska Medical Center who serves as president of the Nebraska Health Information Initiative.
“If you happen to see a doctor in New York,” he said, “those results would end up in an electronic record that could be integrated into your record in Omaha.”
The exchange of information between different systems, which should eliminate redundant tests, still needs work, Frankel said.
“We're a long ways from the nation being totally connected from border to border,” he said.
Dr. Steven Stack, an emergency physician in Kentucky who heads the American Medical Association's health information technology advisory group, said electronic medical records systems will greatly improve in the next five years as more physicians and hospitals get used to them. The current systems, he said, are clumsy and collect too much data.
Although the goal is improved efficiency, Stack said, the conversion initially “makes us less efficient. ... The physicians' productivity plummets and stays suppressed for weeks or months.”
Dr. Clarine Coker, Kay's 67-year-old partner in the Council Bluffs practice, had difficulty adjusting to the electronic system when the office switched to it in 2008. Today, she said, she is proficient on the system and has no trouble finding the information she needs. “You've got everything at your fingertips,” Coker said.
Stack, with the AMA, said implementing the system is a leap of faith.
“This is a large and grand experiment with nearly one fifth of the United States' economy,” he said. “But it's an experiment that the United States really can't afford not to take.”
Contact the writer: email@example.com; 402-444-1109;