Health IT

Electronic medical records powered by billions in stimulus dollars

Billions of federal stimulus dollars are beginning to flow to organizations that are getting hospitals and doctors’ offices ready to adopt electronic medical record technologies.

Once adopted, those technologies are expected to form the backbone of state health information exchanges, eventually creating a nationwide exchange so that any doctor or hospital could get information to improve the safety, quality and efficiency of patient care — and hopefully lower its delivery cost.

Some organizations criticized last year’s Health Information Technology for Economic and Clinical Health Act because it created incentives for adopting electronic record systems to improve care and lower cost rather than adopting innovative medical practices. Others applauded the act for incenting healthcare institutions to invest in technology to raise care quality while lowering its cost. Penalties for failing to adopt the technologies start in 2015.

“In last year’s stimulus bill, there was close to $20 billion that is going to be spent over the next four-to-five years to incent both physicians and hospitals all across the country to adopt electronic medical record technology,” said Dr. C. Martin Harris, the internal medicine physician who is the Cleveland Clinic’s chief information officer. An additional $2 billion is earmarked for developing state health information exchanges.


Who is likely to benefit from the estimated $22 billion the federal government expects to spend to help bring medical professionals into the electronic record fold?

Hospitals and doctors’ offices would benefit. In October, hospitals can begin receiving incentive payments for adopting certified electronic medical record systems, said Harris, who is a member of state and federal committees that are setting standards for and working to implement electronic medical records. Doctors can receive adoption incentives starting in January, he said.

Hospitals and doctors can receive a second incentive payment over the next five years when they reach the “meaningful use” threshold, Martin said. That means they are using their electronic medical record systems to affect their practices in a meaningful way.

Organizations like the Ohio Health Information Partnership also are benefiting from the stimulus money. The partnership was created last year to put in place the state’s health information exchange, and to help hospitals and doctors adopt EMR technologies.

In February, Ohio received $28.5 million in federal stimulus money to help physicians and hospitals move to electronic records. The state is kicking in an additional $5.9 million for a total of $34.4 million, according to Amy Andres, chairman of the partnership and the Ohio Department of Insurance’s chief of staff.

The partnership also was awarded $14.9 million in federal funds, with a state match of $2.1 million, to set up a health information exchange, which is essentially a state-wide computer network that will allow hospitals and doctors’ offices to easily share patients’ health information. Those incentives are “completely separate” from those to be paid to hospitals and doctors for adopting the technologies, Harris said.

For now, most of the effort is being spent on getting healthcare providers to adopt the technology. Last week, Ohio Gov. Ted Strickland announced seven “regional extension centers,” which will receive nearly $27 million of that money to help physicians in their regions adopt electronic medical records. For instance, Case Western Reserve University in Cleveland is getting $7.9 million to help 1,765 primary care physicians.

“Electronic health records tend to be financially out of reach for private practitioners and small practices,” said Julie Rehm, senior associate dean of the Case Western Reserve University School of Medicine and associate vice president of strategic initiatives for the university. “If healthcare providers adopt early, they are eligible for additional reimbursement from the Centers of Medicare and Medicaid Services until 2011. After that, the reimbursement declines and penalties kick in starting in 2015.”

The Cleveland Clinic, which already has invested in its own electronic medical record systems, will get paid to help others do the same. Some of the money for electronic record adoption will go to experts that help small physician practices adopt the technology, Harris said.

“We have a team that does this already” for doctors who practice at the Clinic’s community hospitals, he said. The Clinic team could help unaffiliated doctors figure out what technologies they need, connect them to the technologies, and get them up and running. The team also could help the doctors comply with meaningful use requirements, he said.

One of those requirements is prescribing medications electronically rather than in handwriting, Harris said. So Medco Health Solutions Inc., the pharmacy benefits manager in Franklin Lakes, New Jersey, is working with Medical Mutual of Ohio, the health insurer in Cleveland, to encourage ePrescribing in Ohio.

The program, which began in March and runs through September, will help physicians use personal computers and wireless devices to write prescriptions and send them to pharmacies for filling. The program includes financial incentives for physicians who adopt ePrescribing, Medco said.

“ePrescribing puts life-saving information about adverse drug events in front of the doctor at the point of care,” said John P. Driscoll, Medco’s President of New Market, in a written statement. “It’s a critical component to transforming healthcare from our present system to one that is efficient, sustainable and patient-centered.”

ePrescribing also can save money. “ePrescribing is a proven way of enhancing patient safety while reducing the administrative cost and lightening the workload in physician’s offices. We’re happy to help accelerate its adoption,” said Dr. Robert Rzewnicki, Medical Mutual’s chief medical officer, in the Medco statement.

Companies like GE Healthcare, Epic, Cerner, Eclipsys or Meditech that sell electronic medical record software and systems already are benefiting from the federal incentives through increased business.

Federal policymakers decided in 2004 that most American should have electronic medical records by 2014, according to the Centers for Disease Control and Prevention (pdf). In 2007, the National  Ambulatory Medical Care Survey found that 34.8 percent of office-based doctors were using some sort of electronic medical record. “If those without EMR system in 2007 with definite plans to install one actually do, 53.6 percent of physicians will have some sort of an EMR system in 2010,” according to the March 2010 National Health Statistics Report that summarized the survey findings.

And companies like Hyland Software in Westlake, Ohio, that work with EMR companies also are benefiting from stimulus money. Hospitals and doctors can use Hyland’s enterprise content management system (ECM), called OnBase, to include paper records and unstructured digital information, like electrocardiogram reports, in their electronic medical records.

“Healthcare providers imagine an ideal electronic health record that paints the full patient care picture,” said Susan deCathelineau, Hyland’s healthcare manager. “An EMR alone simply can’t do that. Our 19 percent year-over-year growth in healthcare is the proof. Providers aren’t just thinking about ECM as an application. They’re making it a critical part of their electronic health record strategy.”

$7,942,500 to assist 1,765

primary care physicians.