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Adopting e-health records could cost more than anticipated

Chicago -- Doctors and hospitals could receive as much as $39 billion in economic stimulus funds during the next five years to acquire electronic health record systems, a top Healthcare Information and Management Systems Society official said on the opening day of the organization's four-day conference here.

Though the Recovery Act provided $17 billion for payments to clinicians and hospitals through the Centers for Medicare and Medicaid Services, actual spending could be more than double that figure, depending on the rate of e-records adoption, said Dave Roberts, HIMSS vice president for government relations, during a press briefing on Saturday.

Roberts said the $17 billion in the stimulus package is an estimate of funding needed to meet the act's pledge of giving providers that use health information technology systems in a "meaningful way" $44,000 each during a five-year period to defray expenses, starting with an $18,000 payment in 2010. The e-records initiative is an entitlement program like Social Security, he said.

Roberts said his $39 billion estimate was based on a Congressional Budget Office analysis. CBO estimated that information technology could reduce overall health care costs by $15 billion for that same time period as a result of increased efficiencies, he added.

A January 2009 Commonwealth Fund report by Dr. David Blumenthal, named national coordinator for health information technology in March, estimated that 17 percent of U.S. physicians and 8 percent to 10 percent of U.S. hospitals have only the most basic electronic health record systems.

Federal funding, Blumenthal wrote, would spur adoption of e-records, especially by financially weak or troubled providers such as solo physicians, community health centers and publicly funded hospitals that treat uninsured patients.

Roberts said clinicians planning to adopt a health IT system might want to start with electronic prescription systems, because as of 2012, CMS will impose a penalty on clinicians who treat Medicare patients without using such systems.

Herb Conaway Jr., an internist who is also a Democratic assemblyman in the New Jersey state legislature, told the HIMSS audience that a total payment of $44,000 will not fully cover the costs of a health IT system in a doctor's office, based on his personal experience. During an interview, Conaway said initial costs for his health IT system totaled $44,000, plus ongoing monthly maintenance and support costs of $1,200 to $1,500.

Contrary to common perceptions, "doctors are not rich," Conaway said. He plans to work to secure additional grants to help doctors afford health IT systems.

Charles Campbell, chief information officer for the Military Health System, said during the briefing that clinicians should be able to choose the look and feel of the interface to the underlying software. End users pilloried the interface of MHS' Armed Forces Health Longitudinal Technology Application electronic health record system during a 2008 online town hall meeting.

Based on feedback from that town hall discussion and other Defense health care providers, Campbell said he realized "we need to give providers choices" on a new AHLTA interface planned for deployment later this year.

Campbell also warned that switching to electronic records will be a slow, incremental process. "Don't wait until it is perfect," he said.

Meanwhile, Linda Upmeyer, a nurse practitioner who also is a Republican representative in the Iowa legislature, said during an interview that rural health care providers could benefit from the $9 billion for rural broadband development in the stimulus act. While Iowa operates a statewide government broadband network, stimulus funds could provide last-mile connectivity to help rural clinicians move large data files, including X-rays and MRI scans, Upmeyer said.

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