The effort to convert medical records from paper to digital is expensive – by a rough estimate at least $500 million will be spent in Arkansas in the next few years.
It’s also complex and often obscured by a bureaucratic alphabet soup of acronyms. But doctors, hospitals and their increasingly important teams of health information technologists say the move will be a boon to the practice of medicine.
Why? Two reasons: One, it will improve patient care, and two, it ultimately will lower health care costs because of the efficiencies digital records offer.
"The new currency of the health care marketplace is health information, not just claims information but clinical information," said Ray Scott, head of the state’s Office of Health Information Technology.
(To read about the role of the Arkansas Foundation for Medical Care, click here.)
With all the static around health care reform, one could be forgiven for thinking the move to digital is entirely an outgrowth of that effort, and health care reform does indeed have IT components.
But the digital push – even in Arkansas – began decades earlier, gaining momentum in 2004 when President George W. Bush in his State of the Union Address called for health care providers to move from paper health records, the dead tree world, to electronic health records, the binary world.
"By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care," Bush said. His Health Information Technology Plan envisioned a 10-year timeline.
It took the recession, however, to put some real money – federal money – behind the initiative. As part of the 2009 federal stimulus package, Congress approved the Health Information Technology for Economic & Clinical Health, or HITECH, Act.
It provided $23 billion to drive the use of health information technology by doctors and hospitals nationwide, particularly the creation of electronic health records, EHRs. Most of that money comes in the form of financial incentives to "eligible professionals" who adopt electronic health records. The definition of eligible professionals includes doctors and hospitals, but it also includes health care workers such as physician’s assistants.
Between January 2011 and January 2012, health care providers in Arkansas received almost $43 million in federal money. The federal Centers for Medicare and Medicaid Services oversees the incentive program.
The HITECH Act also birthed the State Health Information Exchange Cooperative Agreement Program. This is a four-year grant program that pushes states to create an infrastructure that lets health care providers electronically exchange information.
To implement these initiatives, Gov. Mike Beebe created the Office of Health Information Technology and the Health Information Exchange Council. The HIT Office is charged with planning and implementing the statewide Health Information Exchange, formally called the State Health Alliance for Records Exchange.
Scott, who has worked under seven Arkansas governors, gave a personal example to demonstrate the importance of easily accessible health information.
"I have diabetes. I’ve had it for 30 years. I know that there are critical pillars of care for me. It’s vision care. It’s heart care. It’s taking care of your kidneys and renal functions. It’s monitoring your blood sugars," he said.
"The problem is that every one of these takes me into a different door to a different part of the health care system. And you know what? There’s not a single doctor that I see who has access to all that."
Scott, as the health care consumer, is the only one who keeps track of every single health issue. "I’m the common denominator," he said. "As long as we are relatively high functioning in terms of our mental capacity, that may be OK," though, he added, even he sometimes forgets exactly what dosages of particular medications he’s taking.
And for the very sick, for the elderly, monitoring every aspect of their health care can be an impossible burden.
The Health Information Exchange, of which electronic health records are a component, is "not about taking that information away from the provider community," Scott said.
"It’s actually about trying to give them access to more, because as good as my cardiologist is, he probably also needs to know what my endocrinologist had to say, what the lab results were the last time they ran them. And unless I specifically ask or there’s some kind of prearranged agreement between those two doctors, that data doesn’t get shared."
Multimillion-Dollar Projects
David House is chief information officer for Baptist Health. In 2010, Baptist Health began what is projected to be a 10-year, $100 million project to digitize many of its processes, including electronic health records.
The project seeks to link Baptist Health’s hospitals and provide better oversight of patient treatment. For example, a nurse or doctor will scan the bar-coded bracelet on a patient’s wrist and then scan the patient’s bar-coded medicine. If something doesn’t jibe, the system is set up to issue automatic alerts.
Baptist Health is using a product created by Epic of Madison, Wis., which makes software for medical groups, hospitals and other health care providers.
"Epic is our strategy to tie all of Baptist Health together," House said. And as Epic expands its footprint to other providers – House thinks it’s the Microsoft of the health care software world – it will ease the transmission of data between Baptist and these other health care entities.
"If you look at what Wal-Mart Stores or a bank would spend on technology, in the health industry, we’re still just scratching the surface of some of the investments that other industries have made," House said.
House noted that Baptist Health had been early adopters of health information technology. "We put in one of the first nurse station order-entry systems in the country, back in 1973, 1974, so we have been making incremental progress toward what I would call a full EMR [electronic medical records].
"I do believe that the stimulus money helped focus and gave us as an industry some emphasis that we didn’t have before," House said. "And I would also say that, especially with our concern about shrinking Medicare reimbursement in the future, we will need to be able to get every bit of that we possibly can in order to stay in business."
"The stimulus money is only going to cover about 20 percent of our cost, so we’re not doing this to make money," he stressed. "We’re not doing this to even break even. We’re doing this because we think it’s the right way to do a better job of taking care of our patients."
Over at the University of Arkansas for Medical Sciences, Chief Information Officer David Miller said that "UAMS has been on the digital path for a long time, since 1998."
Miller, asked how much money UAMS would need to fully transition to electronic health records and where that money would come from, said: "That’s a good question. We’re trying to figure out the latter part of that question as we speak. We don’t know; we haven’t nailed down all the potential funding sources yet."
However, Miller put the cost of implementing "an integrated clinical platform" at $87 million to $90 million.
Miller put the time frame at 24 to 36 months, with the project likely starting in October.
‘A Critical Ingredient’
"We spend more per capita than any other country in the world but yet our health outcomes often lag behind countries less developed than we," Scott said. "Is health information technology the silver bullet? No, but it is a critical ingredient in this because it is the vehicle by which we can use health information more effectively."
"The ultimate objective," he said, "is that we will have a national health information network where, in a private and secure way, appropriate health care providers can access appropriate information to help literally save your life."
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