Wednesday, February 14, 2007
By BOB GROVES, Staff Writer New Jersey Record
Sooner rather than later, doctors will have to switch completely from paperwork to computers if they want to treat patients and make a living in the 21st century.
“To do business with the federal government in the future, everything will have to be electronic,” Michael O. Leavitt, the U.S. Secretary of Health and Human Services, told members of the Medical Society of New Jersey.
Electronic medical records and digital drug prescriptions will eventually be a must for all physicians, Leavitt said during a stop-off in Lawrenceville late last year.
Leavitt was on tour promoting the notion of nationwide, computerized “interconnectivity” in the health care industry. The government funds 40 percent of all health care.
Ten percent to 24 percent of doctors in the United States use electronic medical records (EMRs) to varying degrees to track their patients’ health care, according to a recent study funded by the Robert Wood Johnson Foundation, and cited by the Washington-based Center for Studying Health System Change.
Many physicians in North Jersey and nationally want to change to EMRs, but they fear the cost of converting. Estimates for installing EMR software varies among vendors, from about $10,000 to $50,000 for solo physicians, and up to $100,000 for a group practice. Add to this monthly maintenance and annual update fees, installing high-speed Internet hardware, and paying additional staff to input old data from paper records.
Some older practitioners just plain don’t like or trust computers. Meanwhile, decades of patients’ file folders pile up on floor-to-ceiling shelves in their offices.
Dr. Joseph Friedlander, an internist in Teaneck, is a self-professed “gadget person” who has computerized all his practice’s financial transactions, and uses a Palm Pilot to transmit drug prescriptions to pharmacists. But Friedlander, 53, is reluctant to fully digitize his medical records.
“Why should I spend $50,000 and find out they want us to use something totally different?” he said of the federal government and insurers.
Electronic claims transactions between doctors and HMOs are already standardized with portable personal health records used by 70 million consumers, according to the industry group America’s Health Insurance Plans. The organization also supports physicians’ use of EMRs, which are more detailed clinical records.
The American Medical Association said EMRs hold “promise,” and the group expects the number of doctors using them to rise. The AMA has called on Congress and health insurers to minimize the cost of EMRs to doctors, and to ensure security, standardization and interoperability among EMR products.
The Medical Society of New Jersey is encouraging doctors to convert by offering an EMR system at a discount.
Physicians must keep records for patients seven years after their last visit, Friedlander said. “I have records going back 20 years,” he said. “I have a garage full of charts.
“I’ve just started getting rid of them,” he said. “You have to have a shredding company come in” to destroy the records because of federal privacy laws, he said.
An advantage is that a doctor can access an EMR from anywhere, “and it’s readable, which is a big thing,” Friedlander said.
Technophobia deters Dr. Scott W. Zucker, a pediatrician in Mahwah, from EMR use.
“Certain of us are computer-challenged,” said Zucker, 52. “I’m not sure we’d be able to get everybody on the same page to use it.
Also, for his group practice, with three offices, eight physicians and 50 employees, “the cost [for EMR] can be astronomical,” said Zucker, president of the Bergen County Medical Society. “All three offices have to interface.” On the other hand, “that would be a benefit in terms of following patients who go to different offices,” he said.
“I’m trying to get with the 21st century, [but] I really don’t trust it,” Zucker said of the new technology.
Dr. Laurie Nahum, an internist in Wayne, is shopping for an EMR system, but she wonders how it affects a physician’s bedside manner.
“Will you be typing more than listening to a patient while you’re entering their data into a computer?” said Nahum, president of the Passaic County Medical Society.
But EMRs can send data instantly and anywhere. “It’s the way of the future, as far as convenience for patients,” said Nahum, who has been practicing for 23 years.
Once you take the plunge, EMR is “phenomenal,” said Dr. Arnold I. Pallay, a family physician in Montville who converted five years ago.
“It’s pricey, it’s scary, it’s a big hump to get over to computerize your practice,” said Pallay, 48, one of the first North Jersey physicians to try EMR. “But once you’re there, you can’t go back.”
EMR allows Pallay to look at a patient’s chart, while a nurse reviews a lab report, and a receptionist gives referral information to an insurance company. If a patient has chest pains while vacationing in Bermuda, an emergency physician there can compare EMR notes with Pallay in Morris County.
“A key feature is there are no lost, misplaced or misunderstood charts,” he said.
Doctor-patient relations do not suffer from EMRs, Pallay said. “It’s the opposite,” he said. It “allows more time to talk to patients and deal with them, because recording their visit is so streamlined.”
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