ORLANDO, Fla.—Electronic medical records (EMRs) are costly and require significant staff time to implement but have the potential to bring huge benefits to patients and doctors alike, said speakers at the Triological Society’s Combined Sections Meeting held here Feb. 4-7.
“The reality is that I must be willing to modify my course when I recognize a more efficient way to do business,” said Kenny H. Chan, MD, chairman of the department of pediatric otolaryngology at Children’s Hospital, Denver, after describing the arduous process of switching to EMRs at his institution. “I am but an insignificant speck in the big picture. EMR is here to stay, like it or not, so adapt.”
Brian Nussenbaum, MD, of Washington University School of Medicine in St. Louis, who has worked with EMRs for 9 years, admitted that implementation can be a challenge. “I have seen the good, the bad and the ugly,” said Dr. Nussenbaum, associate professor of otolaryngology-head and neck surgery and vice chairman of clinical affairs. “But today I’m going to talk only about the good. EMR will lead to happier employees and physicians as well as to safer, better quality care for patients.”
Dr. Nussenbaum described how he and other doctors now work from “dashboards,” large computer monitors that are installed in every exam room to display each patient’s records. “You can see everything you need when you walk into the room to see that patient,” Dr. Nussenbaum said. “And, after the visit, the information I enter goes directly into the records and to the insurance company.”
Dr. Nussenbaum and colleagues also do e-prescribing. The transition to computerized physician order entry three years ago would have been far more difficult, Dr. Nussenbaum said, if the hospital had insisted on sticking to the original deadline. “Shortly before the planned date for implementation, we realized no one was ready for it,” he said, “so we went through three more years of development, teaching, training and modifying the system to get to the point that we could introduce it safely.”
Federal Support
In an effort to encourage EMR adoption, the federal government is offering billions of dollars in incentives. To be eligible for these monetary incentives, a hospital or physician group must select an EMR vendor certified by the Certification Commission for Health Information Technology (CCHIT). “It ensures that the EMR they certify have basic capabilities that the federal government believes you must have to provide safe, quality care,” Dr. Nussenbaum explained.
The Health Information Technology for Economic and Clinical Health Act (HITECH), which was part of the recent stimulus bill, has made available $19 billion to promote and stimulate the adoption and use of electronic records primarily through incentives provided by Medicare and Medicaid reimbursement.
The sooner a hospital or private practice adopts EMRs, the more money will be available, Dr. Nussenbaum emphasized. “If you do it each year between 2011 and 2015, you can get $44,000 per physician,” Dr. Nussenbaum said, “but if you don’t start adopting until 2013, it goes down to $39,000. If you adopt in 2014, it goes down to $35,000. And if you start adopting in 2015, you’d have no access to any federal incentive money.”
After that, penalties will be imposed on those who have not yet adopted EMRs. “The penalties start in 2015 with 1 percent,” Dr. Nussenbaum said. “In 2016, it’s 2 percent. It goes all the way down to 2019 with a 5 percent decrease.”
—Brian Nussenbaum, MD
Security Concerns
Udayan K. Shah, MD, FACS, FAAP, filled in for his brother, Rahul K. Shah, MD, FACS, FAAP, co-chair of the American Academy of Otolaryngology-Head and Neck Surgery Foundation’s Patient Safety and Quality Improvement Committee.
Dr. Shah, associate professor of otolaryngology-head and neck surgery at Thomas Jefferson University in Philadelphia, read from notes provided by his brother regarding potential security problems that may result from the switch to electronic records. There’s the danger, he said, of unauthorized access to patient records, such as Social Security numbers and details about chronic health problems such as diabetes and mental illness, which health and life insurance companies might try to use to deny payment.
“There may be holdouts among patients, and our obligation is to show them the advantages of EMR in respect to outcomes, process improvements, and policy imperatives,” Dr. Shah said. ENTtoday