Doctors Allergic To Electronic Record-Keeping
By Thomas Gaudio

 Doctors in New Jersey remain reluctant to bring electronic medical record systems into their offices, despite the federal government championing the technology and laws that let hospitals subsidize some of the cost. Such systems consist of hardware and software with capabilities that include tracking laboratory test results, maintaining patient histories and detecting harmful drug interactions.

Physicians cite hefty startup expenses, lack of time and colleagues’ frustration with previous versions as primary reasons for keeping their records in the paper age.

A Harvard University study this month found that only 4 percent of doctors use full electronic medical systems. Another report from the Robert Wood Johnson Foundation in Plainsboro said small practices are particularly resistant to electronic record-keeping.

This heel-dragging comes four years after President Bush, citing potential reductions in errors and medical expenses, called for all U.S. health care providers to use electronic records by 2014.

Earlier this year, The Centers for Medicare and Medicaid Services in Washington, D.C., launched a five-year project to give 1,200 small-to-midsize primary-care practices around the country financial incentives to switch to electronic record- keeping. And some hospitals are getting into the act by paying for up to 85 percent of software, training and support costs for the practices of affiliated doctors.

Still, adoption remains “very low,” says Stevie Davidson, founder of Health Informatics Consulting LLC in Belle Mead. “Cost is the No. 1 barrier.” Davidson puts the average cost for hardware, software licenses and training at about $25,000, with maintenance costs coming to $4,000 to $6,000 a year.

But Davidson says doctors who use e-records may see higher reimbursements from insurers, since such physicians can document the true cost of care. And larger practices may be able to reduce staff because of the time saved using the technology, she says.

However, the return on investment is “different for every practice,” Davidson adds, and many doctors struggle to figure out how electronic record-keeping can benefit them.

Davidson says her client, South Jersey Healthcare, is looking into subsidizing the cost of e-records for doctors in the five counties the health care system serves. But with many hospitals in the state closing, filing for bankruptcy or operating in the red, she says, doctors generally can’t count on such help.

Joseph Carr, chief information officer for the New Jersey Hospital Association, says few hospitals currently offer such subsidies to doctors. Moreover, he says, medical practices that get money from hospitals still have to “pay a significant amount for equipment.”

Carr says his own doctor spent $170,000 on an electronic system that has made a visit to his office like “night and day” compared with pen-and-paper days.

Michael Rothkopf, an internist with a solo practice in West Orange, worries that hospitals will subsidize one-size-fitsall programs that are not suited to physicians in different specialties and different-sized practices. “The technology is not at a point yet where it can do everything for every doctor,” says Rothkopf. “Whereas a vascular surgeon might only dictate a few words during a brief office visit with a patient, an internist might have a very lengthy narrative.”

Doctors are less worried about the return on their investments than about buying and never using the technology because of the time needed to install and master it, says Rothkopf. “I can think of three doctors who bought EMR systems and never implemented them,” he says.

Rothkopf says he has been using electronic records since 1998 and created software that he later sold to Meridian EMR Inc. He now heads a project for the trade group NJ Physicians that will evaluate and recommend different systems for member doctors.

Rothkopf sees clear benefits in the e-system that he uses. “I went from having four full-time employees to one full-time [employee] and one part-time [employee],” he says. “I don’t have reams of charts anymore. My cash flow is better.”

But he seems to be an exception. Writing in a newsletter of the Medical Society of New Jersey, state Assemblyman Herb Conaway Jr. (D-Burlington) noted that, “large specialty and multi-specialty groups have afforded and purchased electronic medical records and e-prescribing tools, whereas smaller, primary-care offices still cannot afford these technologies.

“As a practicing internist,” wrote Conaway, “I experienced firsthand the entire process of researching, identifying, purchasing and implementing an electronic medical records system in a busy primary-care practice. While most specialties in medicine can benefit from the reductions in cost and medical errors afforded by health information technology tools, the primary-care specialties have the most to gain.”

E-mail to tgaudio@njbiz.com

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