The House Small Business Committee listened to Christopher Normille, M.D. describe how the electronic health record system works in his small family practice. Dr. Normille said that he is a partner in a two-physician practice in St. Charles Missouri, and told the Committee the positive and negative sides in using technology.
On the positive side, he can accomplish a great deal by electronically synchronizing his laptop with the server and can easily transfer information to the office system. When he is out of the office, he is easily able to review lab reports and phone messages, and is able to return phone calls and log in notes to his internet connection where he is able to check on patients in the local hospital. He takes his laptop with him as he sees patients, making notes as he takes histories, and then is able to immediately fax prescriptions. After office hours, he can dictate more complicated information which is transcribed by voice recognition software.
There has been increased efficiency since there are no longer stacks of charts everywhere, and a person does not have to be employed to keep the charts in order, the internet provides valuable information, drug interactions are analyzed with a click of a button, and it is easier to manage a diabetic and/or a chronically ill patient’s course of treatment.
However, Dr. Normille went on to describe how economically and time wise, there are still problems:
- He is not communicating with patients electronically, but in the future when he does, this will be another expense to absorb as this form of communication will not be reimbursed by insurance even if this electronic consultation with the patient is done in lieu of an office visit
- The cost of implementing an EHR system in the practice cost $50,000 and additional annual maintenance costs including software upgrades can cost up to $10,000
- He spends more time at the office because data still needs to be entered into the charts
- When the system was being installed, the number of patients had to be reduced during the time the office was learning to use the system
The Committee then heard how BJC Healthcare, one of the largest nonprofit healthcare organizations in the U.S located in St. Louis Missouri, is installing electronic health records in the BJC Medical Group network of employed physicians. Joan Magruder, Vice President Development and Planning, BJC Healthcare, said “presently, we are implementing an electronic health record system among 200 participating physicians in 65 geographically diverse physician practices covering a 225 mile range, by providing connections to multiple laboratories, pharmacy systems, and BJC hospitals. The system will eventually serve more than 300,000 patients with 53,000 of these patients living in rural areas. We have made a commitment to invest more than $8 million dollars to achieve this goal within the next 24 months.”
She is frequently asked why BJC introduced Electronic Health Records through physician practices. She said that since few physicians have implemented EHR technology since the resources needed are not typically found in these practices, BJC has decided to help this segment of the physician population. Currently, the practices that have electronic records are typically specialty practices and often the records are not interoperable with other existing technology platforms.
According to Magruder, the one time costs to transform a doctor’s office to electronic records range from $30,000 to $45,000 per provider, excluding in-office equipment. So to accelerate the adoption, BJC is underwriting the one time implementation costs, if physicians buy the needed equipment. This equipment, including scanners and printers, averages $10,000 per provider; however, the return on investment can be achieved over 2 to 3 years.
It is hoped that this project will catalyze efforts to create a RHIO consistent with the national vision and at the same time, involve others in the community such as local government leaders, community health groups, healthcare providers, and insurance companies.
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