“If every doctor had that kind of experience once a month, think of all the money and incovenience to the patients that could be saved,” he said.
Critics worry about privacy concerns and medical errors. Doctors seeking cash incentives for going digital must use systems capable of being encrypted. But no federal regulations clearly require that doctors turn the data encryption on or prevent those who don’t do so from getting paid, said Deven McGraw, director of the health privacy project at the Center for Democracy & Technology, an advocacy group.
“This is a point of frustration,” said McGraw, who sits on an advisory group that sought unsuccessfully to prevent those who violate privacy regulations of the federal Health Insurance Portability and Accountability Act, or HIPAA, from getting incentive money.
Joseph Kuchler, a spokesman for the Centers for Medicare and Medicaid Services, acknowledged that providers can operate an electronic system with its encryption turned off. But any that do so are violating HIPAA and face stiff penalties, he said. (As a condition of receiving payments, providers are also required, generally, to protect health information privacy.)
Those potential penalties “will serve as strong incentives to ensure that the encryption technology is not permanently turned off,” Kuchler said.
As a practical matter, doctors say, they keep encryption functions turned on to comply with HIPAA patient privacy rules.
Some studies have also highlighted computer errors and design flaws that can affect prescriptions; others have questioned whether electronic records result in better outcomes. However, a study in the March issue of the journal Health Affairs surveyed the recent literature on electronic health records and found that 92 percent reached positive conclusions.
Still, new systems “will give rise to other problems we may not be able to anticipate,” Blumenthal said. To address those issues, his office gave a grant last December to the Institute of Medicine for a year-long study on ways to improve the safety of electronic health records.
Convenience for patients
Many doctors point out that they bear the biggest costs, while patients and insurance companies benefit most.
Nafeesa Owens, 34, a Springfield mother of twins, loves the convenience. She fills out forms and sends questions to doctors and nurses at her pediatrician’s special online patient portal.
“I’m a big fan. Everything is at your fingertips,” she said, juggling 9-month-old Austin and Zavier during a recent checkup at the Lorton office of All-Pediatrics, a Northern Virginia practice that went digital two years ago.
Tom Sullivan, 72, said all six pediatricians in his practice use laptops perched on tables that they wheel from exam room to office. He calls them “cows,’’ computers on wheels.
During a recent weekday, he is checking 3-year-old Marin Blaya, who has yet another ear infection.
Her exasperated grandmother, Cynthia Blaya, thinks it’s time for ear tubes.
Not yet, Sullivan replies, after checking the girl’s medical history. He prescribes amoxycillin, an antibiotic. Immediately, a notification alerts him to Marin’s asthma and eczema — conditions that may increase the likelihood of allergic reactions. He acknowledges the reminder, then finishes filling the prescription.
“It says you go to the CVS on Franconia Road. Is that still the one you want?” he asks, turning to the grandmother.
She nods. He taps with his stylus. The order is instantly sent.
Doctors say the biggest benefit for patients is having their entire medical record in one place.
“In the old paper days, the chart frequently wasn’t with me when the patient called, and even if it was, perhaps the lab results were in there, but I would have to wade through and find it,” said Moore, the GWU doctor.
All 550 physicians in Moore’s practice, the area’s largest independent physician group, use the same system. Executives won’t say how much it cost, but annual hardware and software maintenance alone runs about $2.5 million, and salary for dedicated IT staff is an additional $3.2 million.
Biggest obstacle: money
Eugene Sussman, who works with 11 other pediatricians in Montgomery County, is on the fence.
He figures it would cost his practice at least $250,000 to go paperless. To help defray the cost, Sussman is considering affiliating with Children’s National Medical Center. Children’s and Rockville-based Adventist Healthcare offer subsidies to doctors if they affiliate with the hospital and use designated vendors.
Even so, Sussman figures that subsidy would cover only about 15 percent of the total cost. The new Medicaid incentives could pay the practice more than $500,000. But there’s a catch: To qualify, 20 percent of a pediatrician’s patients must be Medicaid beneficiaries. At the moment, only 16 percent of the patients in Sussman’s practice are in that category.
The costs “are the biggest holdback nationwide,” said Sussman, 64. “Doctors who are my age, in their early 60s, maybe will retire out. They may think, ‘I don’t need this bother; it’s going to cost more money and cost more time.’ ”