The state, the stimulus, & electronic health

Why Massachusetts is poised to benefit from the push to digitize health records

By: Joe Pinciaro

If you've ever had to read a doctor's handwriting, you might be a proponent of digitizing health records.

Either way, the medical field will be undergoing a dramatic change in the next 5-10 years. The $787 billion American Recovery and Reinvestment Act reserved close to $40 billion to help implement electronic health systems nationwide. Not only would this replace messily-scrawled doctors' orders with legible computer-kept records, but those records would also be transferable with the click of a mouse, saving both doctor and patients potential headaches.

Massachusetts is on board for this initiative - the most expensive item on its state-reviewed, shovel ready project list is a $340 million job devoted to ambulatory electronic health records (eHr's).

"Massachusetts is well-positioned for e-health because we have some national leaders here (Meditech, eClinicalWorks) in the commonwealth," said Anne Marguiles, chief information officer of the state's Information Technology department. "They've been working together for years experimenting and designing models."

Between industry leaders producing software for electronic medical devices and an abundance of medical outfits in the area putting those devices to use, Massachusetts could find itself well-positioned to benefit from the $40 million investment in electronic health.

An e-health primer: eHr vs. eMr and what they can provide

In his blog "Life as a Healthcare CIO," John Halamka, CIO and Dean for Technology at Harvard Medical School, wrote, "Now that Healthcare IT is part of the stimulus and newsworthy, I receive many questions from reporters about the fundamentals of healthcare IT."

To break it down, in his post, "A Healthcare IT Primer," he wrote that an eHR is an "electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff, across more than one health care organization."

Translation?

An eHR is a computerized health record that can be sent from one doctor's office or hospital to another.

"Interoperability" is a key word in Mr. Halamka's definition because if an eHR is limited to one doctor or hospital, it is simply an electronic medical record, or an eMr. Being able to send an eHr between medical outlets will allow a patient's general practitioner to share medical data - allergies, operations, past and current medicine, etc. - to other doctors and hospitals (and vice-versa) with the click of a mouse, therefore making the patients' medical history known to everybody rather than what's on each outlet's paper charts. Currently, few hospitals have the luxury.

According to a study released on March 25 in the New England Journal of Medicine, less than 2 percent of nearly 3,000 hospitals surveyed have a "comprehensive" eHr in place and only 7.6 percent have any eHr system at all.

But according to Dr. Ashish Jha, one of the study's authors, the definition of a "comprehensive" eHR often varies from study to study (Jha's study defined "comprehensive" as having 24 different functionalities - doctor's notes, lab reports, medications, etc.). And from doctor to doctor.

"If you got five different doctors in a room and asked them what makes up an eHR," said Jha, an Associate Professor of Health and Policy Management at Harvard School of Public Health, "you would get seven different answers."

The good news for Massachusetts - as the state often finds in the science fields - is that it's ahead of the curve nationally. Jha estimates that nationwide, 20 percent of doctor's offices currently use an electronic health record of some sort. In Massachusetts, he guesses, somewhere between 35 and 40 percent doctors use one.

Pros and Cons : How will this affect Massachusetts?

Electronic health records do raise privacy concerns that will need to be addressed as the new infrastructure is put into place.

But Dr. Jha's study indicated that the biggest road block in creating an eHr is a lack of capital. This is a problem that the stimulus package is trying to tackle - kind of.

The act makes $36 billion available through Medicare and Medicaid in incentives to doctors and hospitals for setting up an electronic medical system. For those that show "meaningful use" of an eHR by 2011, an annual tiered incentive structure could provide in between $44,000 and $60,000 by 2016. The sooner hospitals and doctors implement the systems, the more money they will be able to receive.

Also, regional extension centers are going to be created to help get doctors learn the new systems, through $2 billion disbursed through the Office of Health and Human Services.

However, vague wording in the law has some questioning how much it could actually help. "Meaningful use" has yet to be clarified, as has what will constitute a "region."

Mitchell Adams, the executive director of the Massachusetts Technology Collaborative, the state's development agency for the advancement of electronic healthcare solutions, calls the implementation of eHR a "highly disruptive process" for doctors.

Doctors get paid according to how many patients they see per day, and if they are learning a new system - and inputting data on their own once they learn that system - that means less time to see patients, said Ray Campbell, CEO of MA Health Data Consortium.

Also, the median doctor's practice in Massachusetts has 3 doctors per outlet, according to Campbell. At $50,000 a pop to install and another $10,000 annually to maintain, a new e-health record system might not be the easiest investment to make - especially if the practices won't see their incentive paycheck for another six to seven years.

"People are excited that the federal government is putting a lot of money into this," said Campbell. "But they're also very disappointed that [the government] doesn't seem to appreciate some of the realities that the people working on the front lines know all too well, which is that small doctors and hospitals just don't have the money to install these systems."

For those hospitals and doctors that do have the money to install an electronic medical system, many will turn to Massachusetts-based companies for the software.

"We want to encourage other states to work with the amazing companies we have in and around this cluster," said Tito Jackson, industry director at the Massachusetts Office of Business Development and member of the information technology task force that proposed the $340 million eHr project.

"We have companies that are world leaders in this space," Jackson added, "and want to make sure they get their fair share and promote them on a national level."

EClinicalWorks, in Westborough, received acclaim in 2007 when it won a $19.8 million contract to automate 200 physician practices throughout Brockton, Newburyport, and North Adams.

Westwood's Meditech just announced a partnership in Kentucky that will automate several doctors' practices.

"We are well-positioned for this initiative as a state," said Mitchell Adams, echoing the sentiments of Ms. Marguiles. "So well positioned, actually, that we might even receive some extra money."