MEDICINE STRIVES TO BALANCE TECHNOLOGY AND PERSONALIZED CARE
Physicians and medical professionals are increasingly employing technology – from computers in the exam room to using big data to analyze the effectiveness of care – but there are growing pains in adapting to the change.
Through the Affordable Care Act and HITECH regulations, the federal government is pushing for the effective use of electronic medical records based on the premise that they increase efficiency by ensuring that health information is available immediately.
Electronic records improve communications among medical practitioners in treating each patient whether local, regional or across state lines.
The transition to the new technology comes with resistance, costs and growing pains.
The approaches of Gainesville physicians Dr. David Black and Dr. Brandon Bodlak illustrate differences in the way practitioners approach change.
Black takes handwritten notes and later dictates them for transcription.
Bodlak dictates his notes into a laptop computer — equipped with voice recognition software — in the presence of the patient at the end of the exam
Black’s comment on using a computer or handheld device in the exam room: “We’re losing a huge amount of ability to communicate with people.
“I’m able to converse, observe and examine,” he said. “Medical records software with pull-down menus is dumbed down and doesn’t reflect who the patient is.”
Bodlak commented, “There were some speed bumps at first, but over the past two and half years of doing things this way, I’ve come to feel good about it.”
The benefits Bodlak sees include verifying his diagnosis and instructions with the patient and avoiding dictating, handwriting or typing his notes later. Similarly, he appreciates the ability to print out a transcription, including his instructions, for patients at the end of a visit.
“I try to maintain eye contact while using the computerized chart as a guide to the visit,” Bodlak said. “I can easily reference vaccinations, health maintenance such as colonoscopy and mammogram dates, as well as easily see notes from specialists.”
The medical practice he shares with Dr. Rene Lee-Pack, Family Practice Associates, spent about $100,000 to set up eClinicalWorks and incurs a monthly operating fee for it.
An expert on healthcare efficiency sees a downside to increasing technology.
“It’s painful, both financially and emotionally,” said Bill King, a partner in DoctorsManagement, a company based in Gainesville and Nashville, and the founder of Gainesvillebased VPI Business Advisors. “Doctors are working longer hours and taking work home.”
These long hours are on top of already demanding clinic and call responsibilities. Also, billing for services rendered can be delayed until the doctor has a chance to get caught up, which adversely affects cash flow, King noted.
“As a result of their increasing time demands sand shrinking profit margins, some physicians are seeking affiliation with hospitals and larger groups,” said King.
While this can offer security, it can also mean a substantial loss of control, and reduced earnings. More precarious is the long-term effect should there be a squeeze put on the hospital systems or the large employers, King added.
Large Practices Coordinate Efforts
As part of a nationwide trend, hospitals are buying medical practices.
HCA, the owner of North Florida Regional Medical Center, purchased Gainesville Family Physicians in 2009.
HCA installed eClinicalWorks, which is much more userfriendly than the practice’s previous system, said Medical Director Dr. George Benchimol.
Hospitalists — hospital-based physicians who treat patients in the hospital when their own physicians aren’t available — can see a patient’s complete chart, Benchimol noted.
HCA also bought Ocala-based Family Care Specialists in 2010. Windy Kemp, who was the chief financial officer for Family Care Specialists, now is the market manager for the 24 HCA-owned medical practices in North Central Florida.
The consolidated ownership provides many benefits for physicians, she said.
“We provide high-level support in electronic medical records, coding, billing and accounting,” she said. “The doctors can focus on patient care.”
Carrot and Stick
The federal government provides both incentives and penalties to encourage medical practices and hospitals to adopt electronic medical records.
Black’s approach isn’t up to federal standards, resulting in Medicare fining him on his reimbursements — he considers it a fair tradeoff, as it means avoiding the $20,000 to $40,000 investment he said he would have to make for a new medical records system.
Bodlak is on schedule with his implementation, qualifying him for a bonus from Medicare, but he sees downsides of the regulation around electronic medical records.
“The theory doesn’t always translate into practice,” he said. “Sometimes, you’re trying to put a round peg into a square hole.”
The federal incentives and penalties are increasing over time as part of the push toward a 2017 goal. That goal is that all electronic health record systems nationwide will be seamless, meaning that information from various proprietary systems will be available (within privacy constraints) across the country.
Julie Shay, RHIA, program director of Santa Fe College’s Health Information Technology Management Program, sees a big payoff from electronic medical records.
Doctors are able to obtain reports from their electronic medical record systems that reflect their clinical outcomes, assisting them in making both clinical decisions on behalf of their patients and administrative decisions. Big data from medical practices and hospitals across the country could be studied with a universal system, which would provide details about the outcomes of care and track cost savings, Shay explained.
“The data mining can be very good for patients, practitioners and researchers,” she said.
Despite the benefits, Shay recognizes the challenges medical professionals face.
“Change is a huge thing,” she said. “It takes time for everyone involved — both patients and healthcare providers — to understand the change and to accept it and realize the benefits.”
As technology is implemented, it must be modified, Shay added.
Realizing the full benefits of electronic medical records will take 10 years, Shay predicted.
“We’ve just scratched the surface,” she said. “But, in the end, quality of health care and the quality of outcomes will be better, comparability of data with other countries will be better and savings will be accounted for.”
Benchimol developed a basic electronic medical records system 25 years ago using an early Macintosh computer. He recalls speaking about his system to the Alachua County Medical Society.
“I predicted that one day, doctors would use computers in the exam room, and everyone just laughed,” he said. “They didn’t believe it would happen.”
Now, his patients are accustomed to him dictating notes as he concludes his visit with them.
“They love it,” he said. “Sometimes what I thought I heard isn’t what they were saying, and we can clear up the misunderstanding.”
Santa Fe College Fills Health Information Management Training Need
Santa Fe College is helping meet the training need for qualified staff to implement electronic health records. The Department of Labor projects employment of health information technicians to grow 22 percent from 2012 to 2022, much faster than the average for all occupations.
The college’s Health Information Technology Management Programs trained 500 students from 2010 to 2013 through a federal HITECH grant that reimbursed students for their tuition upon successful completion of the shortterm, non-creclit program. The SFC HIT program was ranked the No. 1 school in the region for the number of students who completed the training.
Among the students in the associate’s program is Anita Reams. She was teamed with fellow student Theresa Wood in their fall professional practice experience course to perform a security risk analysis for High Springs Pediatrics and Primary Care LLC.
The students suggested ways the medical office could generate reports of each patient’s medical history, and they made suggestions about improving the privacy of records.
“The doctor was ecstatic to learn that he could get more information from his system than he realized,” Reams said.
The technology specialists help in many ways, including teaching patients about using patient portals, tracking the performance of a medical practice and keeping patient records secure, Shay said.
“These workers understand the challenges and know how to manage them,” Shay said. “They are great problem-solvers with strong skills in communications and team work”
Santa Fe offers a latticed approach that allows students to begin their HIT careers by entering the certificate programs, progress to the A.S. degree program and ultimately end with a B.S. degree in health information informatics management program that will begin in spring 2016.
CERTIFICATES INCLUDE:
34-credit-hour medical coder/biller certificate program prepares a student to be a medical coder and biller, as the two functions go hand in hand when paying providers for their services.
24-credit-hour informatics certificate program that prepares a student to understand health data as well as learn the importance of managing data, how to ensure the privacy and security of data and how to aggregate data.
ASSOCIATES DEGREE PROGRAM:
70-credit-hour CAHIIM accredited associates degree program in health information technology where students are taught the operations aspect of any healthcare organization. While the physicians, nurses and healthcare team are taking care of the patient and the patient’s loved ones, HIT/HIM professionals take care of the patient’s health care information, ensuring the information is protected, private, captured, stored and made available when the patient or provider needs it.