Dr. Philip Stevens looks his patients in the eye when he talks to them. After each appointment, he dictates his notes on the visit to one of his assistants, who writes it down in long hand. His office in Tonganoxie doesn't have a computer or fax machine. He has meticulous paper records dating back 57 years.
But even Stevens, 85, acknowledges he's the last of a breed that will soon be extinct: physicians who don't use electronic medical records.
While there is no mandate, doctors who don't go digital by 2015 will receive reduced Medicare and Medicaid reimbursements. Providers who implement electronic systems, meanwhile, get financial incentives from the government.
The American Reinvestment and Recovery Act of 2009 provided $19 billion in funding to implement electronic medical records nationwide. Providers who made "meaningful use" of such systems earned bulked-up Medicare and Medicaid payments, about $44,000 per doctor. Much of that money went toward helping the physicians install the new programs, which generally cost anywhere from $15,000 to $70,000, on top of a monthly maintenance fee.
Nowadays doctors like Stevens are in the minority. About half of doctors' offices and 80 percent of hospitals will have electronic health records by the end of the year, up from 17 percent and 10 percent, respectively, in 2008. And many in the medical community believe it won't be long before most physicians are part of a nationwide network in which they can exchange patients' records electronically — the goal in Kansas is to have 80 percent of providers sharing information digitally by 2016.
But five years after this push began, are digital medical records providing better, less expensive care?
LMH a digital leader
Lawrence Memorial Hospital was an early adopter of electronic records, moving toward a digital system in the early 2000s. The hospital has been recognized as one of the most wired in the country.
CEO Gene Meyer said it will take more time for many of the advantages to be fully realized, but he noted that the new system has allowed physicians to exchange information with greater ease, made records more legible and reduced the duplication of tests. "From a communication and a patient safety and an efficiency standpoint, it's provided a lot of benefits," Meyer said. "But it's been a huge change for the way we do business. It's been a learning curve for physicians."
Lawrence's Heartland Community Health Center plans to use its electronic record system, installed last year, as a centralized database for all of its patients' care, storing appointment records and test results — whether they took place at Heartland or not — as well as hospital reports all in one place.
The Lawrence-Douglas County Health Department, meanwhile, went digital in January. Experts say it takes about 12-18 months to fully implement the systems.
Kim Ens, director of clinical services at the health department, said she expects the switch to help the agency spot health trends in the community and evaluate the efficacy of various programs.
The system cost the department about $66,000, plus a monthly fee of $2,300. Eventually, it is expected to increase the number of appointments the department can facilitate and its amount of billable hours, leading to an estimated savings of $30,000 per year, according to Jennie Henault, director of administrative services.
The department's Project LIVELY program, which helps keep elderly residents in their homes, has already seen results from the new program. Case manager Corey Roelofs used to take notes during visits and then transfer them into the system when he got back to the office. Now, he enters them into an online database he accesses from his laptop while meeting with patients. He also doesn't have to ask identifying information — date of birth, Social Security number — every time like he used to. "It helped us become more efficient, and I feel we can provide better service," he said. "I guess the only down side is now I'm totally dependent on it, and if I forget my computer or lost it, I'd have to go back to a notepad."
On Roberta Woodman's couch at Vermont Towers on a recent afternoon, her pug snorting and watching from the floor, the 72-year-old showed Roelofs a letter saying she had been denied health care benefits. He hit a few keys on his computer and, almost instantly figured out it was a mistake, pulling up the number of the person who could help alleviate the situation. "I have all that information right at my fingertips," he said.
While there are still many technology-averse doctors like the 85-year-old Stevens, Lawrence primary-care physician Ryan Neuhofel, 32, is on the opposite end of that spectrum. He conducts appointments through Skype and FaceTime, communicates with clients through email and Twitter, and has patients sign receipts on an iPad. He doesn't have a single paper record in his office.
It's his opinion that the switch to digital is happening at a pace familiar to the health care field: glacial. He also thinks the initial push for electronic medical records was to make billing and coding easier, mostly benefiting insurance companies.
"If you read a medical chart produced electronically, it's like hieroglyphics. It's a mishmash of codes and outputs," Neuhofel said. "For the simplest encounter — like a follow-up on high blood pressure — the notes are four pages long. If I was talking to a doctor in person, he could say what happened in about 20 seconds."
Because the new programs are so complex, Neuhofel said, doctors often have to have as many administrative employees as before just to manage them.
"A lot of the systems are very hard to use," he said. "I design websites and software programs and I've found myself being very frustrated with how poorly designed they are. When you're used to using very clean designs — a MacBook, an iPhone, Twitter, Facebook — and you sit down on an EMR (electronic medical record system), it's like stepping back in time 15 or 20 years."
While Neuhofel uses a free, Cloud-based health record service, he also doesn't have any federal standards to meet — he doesn't take insurance of any kind, public or private. But even a skeptic like him believes technology will one day make medicine more efficient and patient-friendly — it's just going to take a while.
"Health care is such a convoluted system that nothing moves quickly. It's 10, 15, 20 years behind," he said. "It will eventually happen, just not in the next two or three years."