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Saturday, 21 July 2012 23:38

Deadlines near for doctors to go digital

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GRAND RAPIDS — Lost in the buzz generated earlier this month by the Supreme Court upholding the Patient Protection and Affordability Care Act was a related aspect of health care reform signed in 2009 that encourages hospitals and physicians getting reimbursed for Medicare and Medicaid to digitize their health records by 2015.

Come 2015, the Health Information Technology for Economic and Clinical Health (Hitech) Act adds teeth to its requirements and begins to reduce Medicare and Medicaid reimbursements for those hospitals and physicians that have not switched from paper to electronic records.

The Hitech Act still provides physicians with up to $44,000 in reimbursements from Medicare and $65,000 from Medicaid for meaningful use of certified Electronic Health Records (EHR). Requirements for meaningful use include such things as e-prescribing, electronic exchange of patient health information and reporting on clinical data.

Brookville Pediatric and Internal Medicine in Wyoming, Mich. started converting to electronic health records in 1999 and finished the process in 2008, definitively putting the nine-doctor practice on the cutting edge of technology years ahead of the government mandates on the conversion to electronic health records in 2015.

Office Quality Manager Cristle Weissmiller, effectively the practice's chief information officer, said she would absolutely recommend the conversion to EHR to every practice, whether they take Medicare and Medicaid patients or not. The federal government mandate only applies to practices and hospitals that accept Medicare and Medicaid.

"It's been really good," Weissmiller said. "It really has improved our billing turnaround and efficiency. Reviewing charts is a breeze. Doctors can access charts even when they get called at home."

Weissmiller said she wasn't in charge of implementing the system — which cost roughly $150,000 to set up — but she's been working at Brookville for five-and-a-half years and has seen the impact of the changes. She said the office — with locations in Wyoming and Rockford — runs more efficiently and has improved its profit margin as a result of the conversion. Another bonus with EHR is that patients can go to either office since their charts are available electronically, she said.

The only down side was training the physicians to code the procedures correctly.

"That was never part of their job before," she said. "Some (physicians) are faster on the computer than others."

Brookville's practice is ahead of the curve. Roughly half of the physician practices in Michigan have not started implementing EHR, while the other half "are somewhere along in the process," estimated Dr. Michael Zaroukian, vice president and chief medical information officer at Sparrow Health System. He is also co-chair of the Michigan State Medical Society Health Information Technology Committee.

Zaroukian said when the voluntary Hitech program turns mandatory in 2015, the federal government starts reducing Medicare/Medicaid reimbursement payments to physicians by 1 percent, then 2 percent the following year, capping out at 5 percent later this decade.

"That would put some docs underwater," he said. "The other option for them is to stop taking Medicare patients, but with the billions of dollars at stake, that is highly unlikely."

With the deadline looming, implementing the Hitech Act has turned into this decade's equivalent of the Y2K millennium bug, when businesses worldwide had to scramble to reprogram their computers to avoid what was thought to be a pending electronic meltdown. While the Y2K bug turned out to be a false alarm, meeting Hitech's mandates is not, albeit on a much smaller scale, said John Thayer, sales director at Grand Rapids-based Open Systems Technology Inc. The question now is whether there are enough trained technologists available to meet this huge demand and make the deadline, he said.

"We're doing a lot of hiring to keep up," said Thayer. "We just made an offer to add another recruiter. It's most difficult finding the experienced people. And we have to pay them more money when we do."

Thayer said health care generates about 40 percent of OST's overall revenues now, and that percentage is only increasing. His company has been reaching out to other states to find experienced programmers. Some job postings have gone unfilled for 100 days or more. OST recently hired programmers from Florida and Minnesota to staff up its Grand Rapids office.

"We're seeing a steady growth in business across health care," he said. "We have for the prior four or five years. And we expect to continue to see business booming into the foreseeable future. Unlike Y2K, there are other things that will continue to drive the spend in the health care. Such things as cost control and quality of service are ongoing challenges for hospitals and physician groups that will drive them to become more efficient, more productive for the quality of care. Health care is a great market and we're seeing great growth and hiring on a continuous basis."

The health care practice is booming for Trivalent Group as well. The Grandville IT system consultancy offers everything from consulting services to a one-stop shop for technology, said Tina McConnell, virtual chief information officer for Trivalent.

"We can sit down and listen to what is your challenge," she said. "Do you need to transition in a new director of IT? Do you need an equipment or data center assessment? We determine your challenge and need and see if we can help you solve it."

McConnell said she's been active in all those roles. She was a hospital director of IT. She's been involved in data center hosting. She's worked at implementing electronic health records. What she's learned is this: "If you were going to implement electronic medical records, you need the right staff, equipment, storage for data, network, and need to be able to manage access to help store data.

"The challenge for a technology provider is the closer we get to the deadlines for physicians, the more anxious the physicians are to implement," she said. "The market for health care technology providers and application development is pretty full right now. Those that wait may not be able to get it implemented on time."

But whether forced to or not, physicians have for years understood the importance of having a complete database on patients, Zaroukian said.

"They understand that EHR will improve that," he said. "Safety is impossible without this. We need to be connected to information to make the best decisions. The problem is traditionally, the systems were built more for billing than clinical relevance. They tend to be expensive and difficult to implement. Doctors are not computer specialists by training either. Still, sketchy medical records don't give us the complete picture of the quality of care. "

Zaroukian said patients now expect the highest quality service, and the highest quality technology. He said many patients are surprised when they learn how paper-based physicians' practices are and how disconnected one practice can be from another.

"They have to adopt this technology and learn to use it well," he said. "If you were a patient and trying to decide who to get your care from — someone with great information, delivering a better quality at lower cost, versus someone scribbling on paper and saying they're sorry they can't tell what happened elsewhere — which would you choose?"

The other advantage of the EHR's is they contain clinical alerts and reminders on lab monitoring and medication, among others. He said physicians with their current caseloads don't always remember to provide these alerts to patients.

"It's why pilots use checklists and computers help us manage all aspects of our day-to-day lives," he said.

From his involvement in MHA, Zaroukian said the reaction of his fellow physicians to the Hitech Act has been mixed.

"Some give it an enthusiastic thank you for helping them pay for technology," Zaroukian said. "Others are neutral, saying they have not been provided enough financial incentive to move in that direction. Still others will go kicking and screaming into the health information world. And some physicians will just retire."

Mike Brennan is senior technology writer at MiBiz. His day job is editor and publisher of

Read 1317 times Last modified on Saturday, 28 July 2012 14:44

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