By Callie Shanafelt
California Health Report
Thirty billion dollars was set aside to help Medicare and Medicaid providers move their operations into the high tech world of electronic health records as part of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. Four years later, providers say electronic health records aren’t the time and money saver they hoped for — but, they added, electronic records do improve the quality of care.
Under the legislation, providers can apply for six years of funding to offset the costs of switching to this new way of operating. The earliest qualifiers received their initial grant of up to $63,750 for each provider to purchase certified software, a costly endeavor. The Department of Health and Human Services estimates that it will cost at least double that for a doctor to set up a new certified system, but often costs almost four times as much.
Among the first applicants was Alameda Health Consortium community health clinics, which coordinated their efforts to negotiate a better price with electronic health record vendors. LifeLong Medical Care CEO Marty Lynch, a member of the clinic consortium, said they decided to make the switch because data monitoring is essential to health care reform and improved quality of care.
“We need to use the best technology to assure the best quality, both for individuals and the whole patient population,” Lynch said.
Converting all nine locations in the LifeLong network will cost about $5 million. Lynch said they’ll get about half of that from the stimulus funds.
“As a non-profit community health center, we’re really stuck in terms of how we make up that difference,” Lynch said.
The implementation will likely increase their operating costs in the initial years as providers and staff learn the new system. Despite initial hopes that electronic health records would save clinics money, Lynch thinks they won’t make a difference. It is likely any staff positions he is able to eliminate because of increased administrative efficiencies will be replaced by IT costs.
Some providers have been able to make the switch with the grant covering a greater portion of the costs, said Raul Ramirez, Chief of the California Office of Health Information Technology overseeing the Medi-Cal incentive program.
After the initial infusion of funds to purchase software, clinics can qualify for further funding if they provide proof of ‘meaningful use.’ The 17 objectives of ‘meaningful use’ include using electronic health records for prescriptions, labwork, sharing with specialists and hospitals as well as communicating with patients.
St. Anthony’s Clinic in San Francisco was one of the early adopters of electronic health records. Medical director Ana Valdes said they are trying to decide if it is worth applying for the funding.
Until 2007, Saint Anthony’s handled scheduling and administrative aspects of the clinic electronically with all the information stored on one server at the clinic, until the server caught on fire. Seeing an opportunity to upgrade the system, they joined forces with their sister clinic Glide Health Services to apply for funding for software to manage the clinic and track medical records.
“At that time we were still under the myth of increased efficiency,” Valdes said.
The hope was that electronic health records could save money, increase efficiency and improve quality of care. But the new electronic health records system hasn’t increased their capacity to see more clients.
“It doesn’t matter how efficient your record keeping is,” Valdes said, “it’s based on your patients and what their needs are.”
But Valdes said the one promise electronic health records did deliver on was to improve the quality of care.
“We’re more prepared during the visit. We can show things more easily,” Valdes said. “It reminds you of a lot of things you might not have paid attention to.”
Studies show that electronic health records have significantly improved screening for diabetes, breast cancer, chlamydia and colorectal cancer.
Marty Lynch also hopes the switch to electronic health records will help LifeLong better track their patient population as a whole. For example, hypertension is a big problem with LifeLong patients. In order to track blood pressure with paper charts the clinic had to do individual audits.
“Once the data is in electronic health records we expect to be able to pull records and trends by provider and by clinic and understand better what we’re doing,” Lynch said.
The next major change for the state will be to develop a health information exchange with a consistent form of records that can be shared between providers, specialists and hospitals. This task is proving challenging because of all the competing vendors involved.
Providers are also expected to create a patient portal and use it to communicate with clients in order to qualify for future funding. This presents unique challenges for community clinics.
LifeLong serves more seniors than other clinics many of whom are not as tech savvy as younger clients.
Valdes said at first she assumed her clients didn’t have access to the Internet. She soon learned she was wrong.
“Surprisingly a lot of my patients have a Facebook page,” Valdes said. “I don’t even have a Facebook page.”
Now, she is more concerned that many of her clients don’t have higher than a third grade education. She wants to be careful about posting complex medical information that could cause confusion or worry.
“If it’s something really bad I don’t want my patient to see it on the portal,” Valdes said. “I want to call them up or have a face to face talk about it.”
Also 60 percent of their clients are monolingual Spanish speakers so the vendor would need to provide a multilingual site.
Valdes has yet to see anything to suit her clients.
“We don’t want to make a portal available if only one percent use it,” Valdes said.
Although the switch to electronic health records represents a big shift in the way providers operate, and didn’t provide the savings they had hoped, most say they wouldn’t go back because of improvements to patient care.
Lynch points out that the only way electronic health records may save money is by improving the quality of primary care and reducing emergency care. Cost savings won’t end up in community clinic’s coffers, even through they are paying for the technology that is improving care.
“In our world of community health centers, this is being done on the back of the non-profit organizations,” Lynch said “and that’s frustrating.”