A patchwork of conflicting state regulations may hamper the Obama administration's plan to quickly cut health care costs by transitioning from paper to electronic medical records, say some vendors and hospital managers.
The 2009 American Recovery and Reinvestment Act included about $20 billion to encourage doctors and hospitals to install e-records systems by 2014 as part of President Obama's larger health care agenda. But the planned migration to e-records still could cost hospitals billions of dollars annually because they also must retain paper records.
To cut costs, the administration should replace "overlapping, contradictory and Byzantine state rules" with a single federal standard for the length of time paper records must be saved, states a July 15 white paper sponsored by Iron Mountain, which provides paper and electronic data protection services. Legal requirements for saving paper medical records range from seven years in some states to in perpetuity in others.
"A tremendous amount of the current cost of maintaining patient records comes from the labor involved and the rents paid to manage giant file centers -- in some cases stretching for acres -- on each patient who is treated, regardless of whether an electronic patient record system is in place or not," stated the report, which was written by Ed Santangelo, senior vice president of health care at Iron Mountain.
The report recommends that any health care system overhaul include a 10-year nationwide retention policy for paper and film records, during which time providers would migrate to electronic record-keeping. Iron Mountain estimates providers could immediately cut 35 percent of their collective 500 million paper records by disposing of records older than 10 years.
The approach could ease clinicians' migration to digital records and reduce storage and transition costs up to $11 billion over a 10-year period, according to Iron Mountain. "There should be a strategy in place that allows them to get out of paper or film-based records," Santangelo said in an interview with NextGov.
In the meantime, the company said it is helping health care providers manage analog and digital information through regional consolidation of paper records and by checking for errors and duplicates in the coding of patients visits.
It is widely recognized that, despite widespread adoption of e-records, some medical professionals will choose to maintain patient records on paper.
"Even though we have scanned the complete inpatient discharge, we still have clinicians -- researchers mainly -- that find it easier to read paper than review electronic entries," said Gerry Abrahamian, director of health information management at Beth Israel Deaconess Medical Center. The center is a patient care, teaching and research affiliate of Harvard Medical School.
She favors a seven-year paper retention period and ultimately doing away with paper retention entirely. Today, the center maintains a warehouse filled with more than 2 million paper records and pays an outside firm to store, retrieve and file the paper.
Some hospital officials predict the paper storage debate will subside in seven to 10 years, assuming the entire country converts to electronic health care.
"There is nothing magical about a piece of paper," said Mark Kestner, chief medical officer at Alegent Health, a Nebraska-based nonprofit health care system. Alegent operates one of the most networked hospitals in the country, Omaha's Lakeside Hospital.
"I can assure you there is far less paper floating around in our system than there was five years ago," Kestner added, noting that all the system's nursing documentation is electronic and full conversion to digital should be complete within a couple of years.
Administration officials said they are committed to creating a nationwide health information technology network to improve the quality of care for patients and to reduce medical errors.
"While there is some variation among the years for retention of records, it is our understanding that most states limit medical record retention requirements to 10 years or less. We will continue to work with and respond to concerns from providers and states as we move forward," said Nicholas Papas, spokesman at the Health and Human Services Department.