Sunday, June 29, 2008

Feds ease Georgia’s health care toward the future

“The most important reason to go to electronic records is to cut down on medical errors. People die every year because of medical errors.”

William Bornstein MD, chief quality officer for Emory Healthcare, looks at electronic health files that have replaced the clutter of paper files.
Spencer A. Freeman

The 12 sites selected by the U.S. Dept. of Health and Human Services for its electronic health records pilot project.

Alabama
Delaware
Jacksonville, Fla. (multi-county)
Georgia
Louisiana
Maine
Maryland/Washington, DC
Oklahoma
Pittsburgh, Pa. (multi-county)
South Dakota
Virginia
Madison, WI (multi-county)


By Spencer A. Freeman

Steve Katkowsky resigned as Fulton County’s health director in February. He was the go-to guy for biohazard preparedness plans, vaccination trends and observations on the successes and failures of public health in general. He left Atlanta for the metropolitan Cincinnati area where, he says, he could make his mark in developing an independent health district from the ground up. The new gig offered exciting new challenges.

But once he had taken up his post as director of health for the Northern Kentucky District Health Department—which includes part of metro Cincinnati—he found himself confronted with a familiar problem: a lack of electronic health records.

    “I am instituting electronic health records here because I think it’s such an issue for liability and for good patient care, and not to do it would be senseless,” says Katkowsky.

To illustrate the importance of electronic health records (EHR), he points to erroneous prescriptions. The culprit? Illegible handwriting. Doctors scribble something down and pharmacists do the best they can to interpret it, and the patient is the victim of the errors that ensue. A computer printout, generated by a handheld device like a Palm Pilot, would help tremendously.

    “The most important reason to go to electronic records is to cut down on medical errors,” he says. “People die every year because of medical errors.”

If Katkowsky had stuck around, he might have witnessed the federal government helping some medical practices in Fulton County transition to electronic records. Mike Leavitt, secretary of the U.S. Department of Health and Human Services (DHHS), announced in mid-June that Georgia will be one of 12 sites to participate in a pilot program beginning next fall that aims to introduce an EHR system to small primary care physicians.

The five-year project, administered by the Centers for Medicare and Medicaid Services (CMS), is the first of its kind. Experts interviewed by The Sunday Paper say that EHR can cut health care costs by putting an end to shuttling patients from one provider to another for tests and procedures that may already have been performed. Such duplication can delay treatment and cost patients their lives. Additionally, EHR will make charges for procedures uniform, decreasing the chance of over-billing.
 
And the system may make it easier for doctors to report and track outbreaks of communicable diseases, as required by the Centers for Disease Control and Prevention (CDC).
“That’s important,” says Katkowsky. “If you went into a practice right now and you asked, ‘How many cases of pneumonia are you seeing?’ The doctors might say ‘We’re seeing a lot,’ but they won’t be able to tell you the exact number they’ve seen in a given time period. In tracking diseases, that matters.”

GRADUAL CHANGE

DHHS claims that its electronic records program is likely to improve health care quality for more than 3.6 million Americans. However, that won’t happen overnight. Like most communities, the medical community doesn’t always embrace change.

“There is always a risk with change, even when heading toward improvement,” says William Bornstein MD, chief quality officer of Emory Healthcare. “I think that the federal government is doing the right thing by helping to facilitate the adoption of [EHR] because I think this is the future and it is a tough transition, and it’s the toughest transition for small practices.”

The New England Journal of Medicine reports that less than 9 percent of small practices have an EHR system. The DHHS program “is aimed at small, private practices because most do not have the financial support or the technical expertise to implement such systems,” says Renea Steele, director of the Office of Health Information Technology and Transparency for the Georgia Department of Community Health.

Diane Weems, chief medical officer of Chatham County, is optimistic about the project because some physicians in Savannah have already begun implementing a similar program.

“Some of our sites had no computer systems at the start of the project,” says Weems. “We believe strongly that these systems will be able to improve efficiencies in our network, promote electronic prescribing, and reduce medical errors.”

The DHHS electronic records program will be launched in two phases. Phase one will begin with physician recruitment for the project in fall 2008, followed by the introduction of the EHR system into selected practices.

“Our initiative in this first year is focused on building the foundation to provide for the future implementation of electronic health records among our safety net provider network, including federally qualified health centers, volunteer medicine clinics, public health and our hospital emergency rooms,” says Weems. Those participating will be provided with monetary incentives to be used at their discretion to either purchase health-information technology or to manage patient care. The amount of incentive rewarded to each practice will vary depending on EHR usage.

In order to qualify for the project, physicians must meet two main criteria. First, an applicant’s practice must have between five and 10 staffers, including physicians and ancillary personnel. Second, the practice must be able to implement the EHR system by the end of the first year of project participation. Preference is given to practices that provide health care to underserved communities as well as to patients on Medicare.

The federally funded program gets added support from the EHR Community Partnership, whose members vary from large medical groups including Emory Healthcare and Kaiser Permanente to small care providers like Gainesville Eye Associates. The primary role of the EHR Community Partnership is to help recruit practices that are eligible to participate in the pilot program.

While each EHR system may vary based on the type and extent of information stored, all will be required to perform four core functions: storing and providing clinical documentation and patient history for review; providing an easy way to order clinical lab tests; allowing access to view test results; and communicating with pharmacies to prescribe medication. In addition, all EHR systems will be able to exchange information with each other and with other systems. Each system is equipped with a security program, which will ensure that only authorized physicians and nurses can view patient information.

Although EHR systems provide physicians with a more streamlined method for sharing information, the systems must comply with the Health Insurance Portability and Accountability Act, which protects the privacy of patient health data.

“If you have a new tool available to help you improve patient care, why not implement it?” asks Katkowsky.  “It’s like penicillin—once we got that, we used it.” SP

News editor Stephanie Ramage contributed reporting to this article.