It took four years beginning in 2004 for Dr. Jen Brull’s family medicine practice here to implement an electronic health record system last year.
“If we’d had the stimulus money on the table, we could have done it in six months,” she said. “The biggest part of our process was deciding if we could afford it.”
The system chosen by Brull’s practice is likely to meet the requirements of the American Recovery and Reinvestment Act, which includes about $17.2 billion in incentive payments for providers who move to electronic recordkeeping over the next five years.
The Obama administration and others are convinced that widespread use of health information technology will reduce health care errors, improve efficiency and ultimately save money.
“Everything I’ve read says ours should meet the criteria,” Brull said. “It looks like over a five-year period we’ll get a little over $48,000 per physician, and there are three of us in the practice.”
The system Brull’s practice chose allows the physicians to e-prescribe medication, sending prescriptions electronically direct to pharmacists. It also can be used to send and receive information from other systems in what is one of the state’s few health information exchanges. The exchange exists thanks to Kansas Department of Health and Environment grant programs – which bring in about $5,000 each year – to monitor patients with diabetes and hypertension. Brull’s system also can record quality improvement information.
The new federal incentive money, she said, will almost completely reimburse the physicians for their health records system, she said.
“It’s a good chunk of money I wasn’t expecting to get back,” she said.
Cost of electronic health records systems has been a major barrier that providers have struggled to overcome, said Dr. Joe Davison, a Wichita physician who served on Gov. Kathleen Sebelius’ Health Information Exchange Commission.
The stimulus money for providers is expected to come through increased Medicare and Medicaid reimbursements, Davison said.
One possible scenario: Depending on the number of patients enrolled, a physician could see $15,000 in the first year, $18,000 in the second, $12,000 in the third and then a gradual tapering-off from there. According to a Kansas Health Policy Authority analysis of the HIT provisions in the stimulus, providers who don’t make the switch to electronic records could face penalties starting in 2016.
“Other barriers,” to adoption, Davison said, “are how effective it is to bring into the office, how it affects workflow. Others are about security and privatization of it. Other barriers have been the ability to develop interoperable systems. But I think the biggest barrier was cost, and that’s what this ARRA is directly aimed at trying to overcome.”
Federal aid may not be helpful
Dr. DeAnna Vaughn has used electronic medical records since she opened her practice in Neodesha in 2006, starting fresh with an almost-paperless office.
She said she hadn’t done much investigation of the stimulus package, but that she is probably not interested in working to obtain the incentives.
“The overall thing is that we need to wait and see what kinds of strings are attached and what the requirements are going to be,” she said. “For a smaller practice, the strings that are attached to the incentives will potentially be cost-prohibitive.”
Vaughn’s system is capable of e-prescribing. But she doesn’t use that feature because few, if any, of the local pharmacies she uses could receive and respond to the messages she would send.
“There are a lot of pharmacies in rural areas that are not capable of doing that — even if we are, they’re not,” she said. “I don’t want to be all doom and gloom — there may be some things that will work. But sometimes, the things the federal government asks us to do are not feasible.”
Even without federal incentives, she said, her practice has found cost-effective ways to afford an electronic record system.
“You have to invest time and energy into it,” she said. “You have to find vendors who will negotiate with you.”
A partner’s spouse helps the practice with IT issues, which has also helped keep costs down.
“We’re very fortunate,” she said. “If we had to pay somebody $150 an hour to drive from Wichita or Kansas City to Neodesha, Kan., that would be very cost-prohibitive. It would be a huge deal to find some way to help those smaller practices in rural areas be able to afford IT support. “
Infrastructure barriers, uncertainty remain
Davison said he supports the federal effort, but it won’t necessarily be an easy road for doctors even with the financial incentives.
For example, providers must purchase or already own a certified electronic health record system to qualify for stimulus money, Davison said. The system must have been approved by the Certification Commission for Healthcare Information Technology. And given that the effort is nationwide, there may not be enough vendors to meet demand.
“They’ll start the incentive payments in 2010,” he said. “There are less than 20 vendors that have products that are CCHIT certified. That’s not enough.”
E-prescribing is not yet widely used, he said. And the available workforce of technologists needed to install and maintain electronic health records likely won’t meet the demand created by the stimulus package.
“I think it’s a great deal,” Davison said. “I think it will help stop duplication of services and save money. All the things it promises, I think, are true. But there’s going to be a lot of give-and-take, and alternations will need to be made. It won’t be a smooth trip. It’s going to be start-stop.”
-Sarah Green is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. She can be reached at sgreen@khi.org or at 785-233-5443, ext. 118.