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Doctors not in stampede to go digital

By Catherine Arnst
Globe Correspondent / May 4, 2010

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President Obama has earmarked some $35 billion in stimulus funds to spur a nationwide rollout of computerized medical records, but even a big dose of federal cash is not enough for physicians like Dr. Robert LeBow of Southbridge.

The 66-year-old internist and geriatrician cares for more than 1,000 patients, many of them elderly, with multiple ailments with multiple medications. These are the kinds of patients who produce paper records that are inches thick, making LeBow a seemingly ideal candidate to collect $44,000 in federal funds available to doctors who install a system that would digitize all that information.

But LeBow is reluctant to embrace a technology that he believes carries hidden costs, chief among them productivity losses while he and his staff master the system. Also, for many doctors, the government subsidy would cover only a portion of a new records system’s price tag, which can easily climb to $100,000 or more.

Electronic medical records “are quite complex and controversial, and a lot more expensive than they would seem on the surface,’’ said LeBow — so he may just forgo the federal government’s money. And if he does, he knows he will also have to accept a lower Medicare reimbursement rate that will be imposed as a penalty on any doctor who hasn’t gone digital by 2015.

LeBow is part of the professional resistance to electronic records systems that computerization advocates say threatens the goals of the new health care overhaul law. These advocates argue that using computers to track what care patients receive, for instance, is vital to deciding what medications and treatments work best. Digital records also help reduce duplication and waste, they say.

And for patients, the issue has impact far beyond costs: Evidence suggests electronic records can save lives.

The US Department of Veterans Affairs has reduced prescription errors to almost zero since switching to electronic records, far below any hospital in the United States. And an MIT researcher reported last year that a hospital that adopts electronic medical records can reduce infant deaths by 13 for every 100,000 live births.

But big provider groups, including the American Hospital Association and the American Medical Association, are lobbying the federal government to slow its push for adoption of the expensive and complex systems, even though two surveys by The New England Journal of Medicine last year found that just 1.5 percent of hospitals and 4 percent of doctor practices have comprehensive electronic records.

Saying the government is demanding “too much, too soon,’’ the hospital and doctor groups are asking for fewer conditions on the federal stimulus money. They also seek to extend the deadline for stimulus payments from 2015 to 2017.

That dismays advocates, who say the health care system desperately needs to catch up to the rest of the nation’s economy.

“The nation’s waited long enough. We should have done this 10 years ago,’’ said Dr. David Brailer, who was the national coordinator of health information technology under President George W. Bush and is now chairman of Health Evolution Partners, an investment firm in San Francisco.

But Brailer acknowledges that the health care sector’s powerful lobby will probably persuade the Obama administration to relax its schedule before the money starts getting distributed in October.

At a conference sponsored by Governor Deval Patrick last week in Boston, where the high number of teaching hospitals has been a factor in better computer recordkeeping rates, speaker after speaker extolled the benefits of digital medical records.

One of the speakers, Dr. David Blumenthal, Obama’s coordinator for health information technology and former director of the Institute for Health Policy at Massachusetts General Hospital, said in an interview that no doctor or hospital is required by law to adopt electronic records.

“However, my own view, as a doctor who has used [electronic medical records] for almost a decade, is that it is fast becoming a professional responsibility that will be the standard of care in the 21st century,’’ he said. “I would hope professionalism and the desire to keep up with the best in the field will push physicians to adopt these systems as much as the financial incentives.’’

Fifty organizations, including Consumers Union, the American Association of Retired People, and the National Retail Federation, sent a joint letter to Health and Human Services Secretary Kathleen Sebelius on April 20 asserting that they “strongly support’’ the current federal requirements for electronic records, and want no slowdown.

“Other industries have long viewed [information technology] investments simply as a cost of doing business,’’ the letter said. “The health care sector has lagged behind in this evolution.’’

The VA offers a big argument in favor of digital health records. According to a study in the April issue of Health Affairs by researchers from Massachusetts General Hospital, the VA spent $4.07 billion to install its system and completely wired its 1,400 hospitals and clinics by 2004. But the resulting efficiencies have saved it $7.16 billion to date — a $3.09 billion net gain.

The Department of Health and Human Services estimates it will dole out $31 billion to $45 billion in stimulus payments— $44,000 per system to doctors and $2 million and up for hospitals. The Congressional Budget Office calculates the government will ultimately save $12 billion in health payments over 10 years as a result.

To get the money, medical providers must prove that their systems are capable of “meaningful use,’’ and the debate over the definition of “meaningful’’ has grown fierce. In December the Obama administration proposed that a system would not meet that standard unless it satisfied at least 25 criteria, such as the ability to share data with other doctors, transmit prescriptions directly to pharmacies, and electronically track all updates on a patient’s condition, even when recorded by multiple specialists.

Many doctors worry that promised savings to their practices will not materialize. And there are plenty of examples of frustration with computers on the front lines.

“If this is a cost saver, I don’t get it,’’ says Dr. Michael Cohen, 49, a nephrologist in Wakefield who uses electronic records.

Cohen often can’t send crucial patient information to other physicians because their systems are incompatible. He finds that the records contain so much data that important information can be buried. Mistakes in the records, he said, can be hard to detect and change.

“I agree that a good working system can be an incredibly powerful tool, but there’s an incredibly steep learning curve,’’ said Cohen.

Most vendors who make the computerized systems are offering a money-back guarantee that their systems will meet the government’s meaningful use standards.

“For doctors that aren’t used to computers, it’s a big change to the way they work,’’ said Dr. Michael Coffey, 37, director of informatics at Hallmark Health System, which operates Lawrence Memorial Hospital and Melrose-Wakefield Hospital.

Hallmark started the switch to electronic records in 2006 and now has more than 100 doctors wired in. Coffey, who is also a family practitioner, concedes that there have been many challenges in implementing the systems, “but honestly, now that we have it there is no way I would go back to using paper.’’

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