The Paperless Office Electronic Medical Records Force a Culture Change for Physicians

It’s a ritual well-known to Americans who see the doctor: at the start of the visit, the physician or a nurse peruses shelves containing hundreds or even thousands of charts, and pulls out the appropriate one. Inside is a record of that patient’s medical history, recent conditions, and treatments.

But the health care industry is moving — to some degree pushed, actually, by the U.S. government with a planned series of financial carrots and sticks — toward a day when electronic medical records (EMR) are stored on a computer drive.

The next logical step from there is a completely paperless office, in which even communication between doctors and other employees is conducted on screen. It’s a major culture change, said Delcie Bean IV, president of Valley Computer Works in Hadley, who works with physician’s offices to transition to EMR and will soon host a conference for doctors to learn more about going paperless.

“We are an IT integrator,” Bean said. “We help practices first choose the electronic medical record system they’re going to use, then we work with them to get all the steps in place to do the work ahead of time, get all the requirements right forms created get hardware installed so the implementation goes off without a hitch. Once that’s done, we maintain and take care of everything.

“At first, it’s a huge adjustment from writing everything down on a piece of paper to electronically entering it,” he noted. “Paper gives you the freedom to do whatever you want; unlike a big, empty notepad, you’re limited in what you can enter in the field, and there are special forms to fill out. So at first, it can take a long time to learn what the processes are.”

Knowledge Is Power

To that end, Bean’s company will host a conference for physicians and other health care practitioners on July 22 from 6 to 8:30 p.m. at the Courtyard Marriott in Hadley. It’s the first of what Bean says will be many such events aimed at helping local medical practices understand the laws that will require them to adopt EMR in the coming decade.

Also on the agenda will be an explanation of the federal stimulus package, which has earmarked $19 billion specifically to help medical offices bear the expenses associated with the implementation of electronic medical records.

Specifically, the stimulus bills sets aside incentive money to be awarded to physicians that demonstrate “meaningful use” of EMR. Physicians can earn between $2,000 and $18,000 in a given year. The U.S. Ddepartment of Health and Human Services will define the clear definition of “meaningful use” in the year ahead, but it will involve demonstrating use of the technology to improve care quality and submitting care quality measures to HHS.

Meanwhile, those providers who are not adopting EMR by 2015 will see reductions in their Medicare reimbursements of 1{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2015, 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2016, and 3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2017.

During these forums, officials from Valley ComputerWorks will talk about the entire process a medical office must undertake to go paperless, from selecting an EMR provider through the implementation and adoption. Common pitfalls and mistakes will be discussed, and local doctors who have already completed the transition will share their experiences.

Three different EMR vendors will attend the event, each giving a brief demonstration of its product, allowing the attending doctors to compare, side by side, a few of the key players in the EMR industry.

For Valley Computer Works, this new service niche came about by happenstance, but it’s one that Bean is happy to embrace.

“A few of our clients happened to be medical offices that decided to be early adopters of EMR before everyone else,” Bean said. “Since then, we definitely saw an opportunity to become the local expert, so that doctors have someone to go to.”

There’s definitely a need for that expertise, he explained. Anytime a practice sets out with a new record-keeping and communications system, there is a danger for staff frustration, longer patient waiting times, and even treatment errors, such as a patient being administered the same medication twice.

“There have been mistakes,” Bean said, adding that he knows of no fatalities due to errors related to such system changeovers. “It’s such a big investment, and such a complex procedure, that you need to work with someone that knows what they’re doing.”

Growing Pains

Diane Lares, consulting manager for PMSCO Healthcare Consulting in Pennsylvania, writes at Physicians News Digest (www.physiciansnews.com) that many doctors are uncomfortable with the coming transition, even though most see it as inevitable.

“The paper chart is very comfortable for clinicians,” she notes. “Although there are difficulties in finding charts periodically (up to 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the time according to some studies), and finding information in the chart sometimes proves challenging, the thick chart has a strange allure to physicians. Having the information available in a hard copy is appealing. Some physicians, who have had little exposure to electronic medical records or computers, find that the transition from paper to electronic can be emotionally traumatic.”

There’s a cost factor, too, said Dr. Peter Polack, president of Protodrone, a software-development company specializing in medical-practice operations. Writing at buzzle.com, he details several implementation costs, including computer hardware, software licenses, infrastructure, consulting, and tech support.

“There are other costs to consider, including extra hours that will be spent doing data entry or training on the new system,” Polack added. “Usually a practice will use both the old and new systems together until a full conversion has been completed; in the meantime there may be some redundancies.”

No one said it would be easy, Bean admitted. “It’s a critical process; you can lose staff, lose patients, cause injuries — you could even go bankrupt,” he told The Healthcare News. “You’re investing $50,000 to $60,000 in this, so if it everything goes wrong, that’s out the window. You don’t get that back.”

Even the concept of ‘paperless’ isn’t totally accurate — yet, Polack notes.

“If you decide to scan all of your paper records into an electronic format, still you may not succeed at completely eliminating the use of paper forms at your practice,” he said. “Some paper-based forms must be kept for legal and regulatory compliance. So, it may not quite be time to sell all your file cabinets quite yet. It could be a long time before we see the day when all medical documentation is generated and stored in electronic format.”

Yet, that day seems closer than ever before.