Physicians debate computerizing medical records


In 2003, President Bush said he wanted most Americans’ medical records to be computerized within 10 years. The savings from moving away from paper could rise into the hundreds of millions a year, the president said. And electronic records can reduce medical errors, proponents said.

Five years later, only a third of Texas physicians surveyed by the Texas Medical Association are using an electronic medical record system, up from 27 percent in 2005.

Some doctors say the shift costs too much and takes time away from their main job of treating patients as they sit at a computer typing in information from old paper folders.

Plus, they worry any system they buy may be incompatible with those used at other physician offices or hospitals, eliminating much of the benefit of having records that – at least in theory – can be easily shared.

On the other hand, medical professionals like Dr. David Arai, chairman of the emergency department at the Centennial Medical Center in Frisco, can’t imagine working without the electronic record system he put in four years ago. Using electronic record software purchased from Addison-based Medhost Inc., Dr. Arai can order X-rays and tests from the patient’s bedside on his portable tablet computer, which is about the size of a thick folder.

If he prescribes the wrong medication to a patient, the computer alerts him: “Do you really want to prescribe this drug? The patient said he’s allergic.”

Medical mistakes from sloppy handwriting also are eliminated, he says – magnesium and morphine look awfully similar scribbled on paper.

And with paper charts, “only one person can have it at a time,” Dr. Arai said, while several people can view an electronic record by simply tapping into the system.

Budget concernsThe size of a doctor’s budget often plays a major role in how the technology is viewed. Small physician practices with modest revenue are more likely to question the investment. Doctors who benefit from a large hospital’s capital spending budget are more apt to trumpet its benefits. 

For instance, Arlington-based Texas Health Resources Inc. plans to spend $200 million over the next 10 years to transfer records and train its staff to use the new system. Dallas-based Baylor Healthcare System has budgeted $240 million through 2011. Officials at both hospital systems are upbeat about their investment and say they expect to see savings and quality improvements.

Meanwhile, small practices with a few doctors struggle to justify the $5,000 to $50,000 per physician initial cost, plus more than $1,000 a month to keep the system running. Those physicians cite the lack of shared risk and reward, where the federal government and insurance companies offer little financial help but receive most of the savings.

Dr. Fred Ciarochi, a Duncanville endocrinologist, agrees with the 25 percent of 473 survey respondents with no plans to implement an electronic records system. He’d like such a system, but he says the $35,000 to $50,000 price he was quoted is too steep. He’s brainstormed about less expensive high-tech recordkeeping methods, such as putting medical information on USB flash drives that patients would wear.

More worriesMoney isn’t the only issue for doctors. In the TMA survey, 45 percent complained it was too awkward and time-consuming to input data. About 43 percent said productivity was lost during implementation of the system, and 41 percent reported they feared new kinds of errors, such as a systemwide shutdown or other electronic glitches.

In addition, electronic record systems vary, and not all are compatible and can transfer information to each other.

That lack of compatibility discourages many physicians from cashing in on the U.S. Department of Health and Human Services’ Stark Exemption program, which subsidizes up to 85 percent of the cost of electronic record software for hospitals and insurers, said Joe Schneider, a pediatrician in Baylor’s network who also chairs the TMA’s Health Information Technology Initiative.

Only 17 percent of physicians in the TMA survey reported that the cost of their electronic record system was subsidized by a hospital, government agency or other sponsor.

“A hospital may come along and say, ‘We can give you this great deal on Vendor X,’ but if Vendor X goes out of business or doesn’t respond well to my needs, I’m stuck,” Dr. Schneider said, explaining why some doctors shy away from the subsidized programs.

Secrecy prevailsDoctors are also reluctant to sign on because it is difficult for them to gauge whether they are getting a good deal. Because of all the pricing secrecy demanded by vendors, doctors have no way of knowing how much it generally costs to maintain an electronic system, said Pamela McNutt, senior vice president and chief information officer of Dallas-based Methodist Health System. Ten percent of physicians in the TMA survey reported that actual costs exceeded the vendor estimate by more than 50 percent.

“The big cost overruns on the electronic health records are beginning to become an industry scandal,” said John Hummel, chief technology officer of health care at Perot Systems. Before joining Perot Systems in January, Mr. Hummel installed electronic medical records throughout California’s prison system.

Dr. Ciarochi, the Duncanville endocrinologist who treats low-income diabetic patients, has turned to cheaper, makeshift solutions.

“My practice is in South Dallas, and we don’t have a lot of money,” Dr. Ciarochi said. “Basically we have the ‘Poor Man’s Electronic Record’ – our patients carry index cards with them.” The cards list the patient’s brief medical history.

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