Despite incentives, doctors are wary about switching to electronic health records

Tom Sullivan enters data he has just collected from patient Marin Blaya, 3, into his laptop at the Lorton office of All Pediatrics. His practice has been using computers to track patients' medical records for two years.
Tom Sullivan enters data he has just collected from patient Marin Blaya, 3, into his laptop at the Lorton office of All Pediatrics. His practice has been using computers to track patients' medical records for two years. (For The Washington Post)

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By Lena H. Sun
Wednesday, March 16, 2011; 10:54 AM

With funding and technical support from his employer, Washington internist Brad Moore made a swift transition to electronic records seven years ago. He now pulls up a patient's chart with a few clicks of his mouse.

Lab tests show the man, a diabetic, has his blood sugar under control. A surgeon's note describes progress after a shoulder operation. Before heading to the exam room, Moore, 47, clicks on a yellow "FYI" button, the electronic equivalent of a sticky note. It reminds him to ask how his patient is doing after his wife's recent death.

About 20 miles away in suburban Maryland, internist Jonathan Plotsky hunts for the same kind of information in charts, some of them six inches thick, others taking up three volumes. He is well aware of the benefits of electronic records, but like most U.S. doctors, Plotsky, 56, is hesitant to switch. At up to $50,000 per clinician, the systems cost too much for him and the part-time doctor with whom he practices, he says. He doesn't know what to buy, how to install it or how he would transition to paperless.

"I'm waiting to see what will work for people," he says. "The cost is prohibitive. It won't be any more revenue, and it will change the way I do things."

This spring, the federal government will ramp up cash incentives to encourage doctors such as Plotsky to take the step Moore barely thought about in 2004 when George Washington University Medical Faculty Associates introduced its practice-wide electronic system. Under an ambitious plan to modernize health care in much the same way paperless technologies have revolutionized banking and retail, federal officials plan to provide up to $27 billion over 10 years to encourage doctors and hospitals to go electronic.

More than 500,000 doctors, dentists and nurse practitioners could qualify for the federal incentives, which are part of the 2009 economic stimulus program. But at least two deficit-reduction bills have been introduced in the House that target the payments as part of unspent stimulus funds. Those efforts are unlikely to succeed, said health-care IT analysts, because Democrats control the Senate and President Obama is almost certain to veto any move to strip money from the project.

All this leaves doctors such as Plotsky confused about the federal government's carrots and sticks.

Many are aware that beginning this year, health-care professionals who effectively use electronic records can each receive up to $44,000 over five years through Medicare or up to $63,750 over six years through Medicaid.

But to qualify, doctors must meet a host of strict criteria, including regularly using computerized records to log diagnoses and visits, ordering prescriptions and monitoring for drug interactions.

And starting in 2015, those who aren't digital risk having their Medicare reimbursements cut.

Nonethless, Jay Bernstein, a Rockville pediatrician, remains more adamant than Plotsky. Going digital should not be a mandate with penalties, he believes. And the benefits, such as more accurate documentation, are outweighed by costs - both in dollars and in the changes that making the switch would bring to his work.

"These ivory-tower types try to boil down the art and practice of medicine into something that can't be boiled down," said Bernstein.


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