For the last few years, transitioning to electronic health records, or HER, has not always been smooth.
For smaller doctors' offices and independent physicians, the biggest concern has been the costs associated with integrating medical records.
According to a report published by The Center for Public Integrity, researchers following a group of primary care physicians in Texas said it cost on average $233,297, or $46,659 per physician, at a five-physician practice in the first year to implement and learn how to use an EHR system.
Trinity Mother Frances Hospitals and Clinics has invested $80 million, while East Texas Medical Center Regional Healthcare System has spent an estimated $20 million, and counting. So far, The University of Texas Health Science Center at Tyler has invested about $6 million to purchase software and implement it.
While federal stimulus funds and becoming part of an incentive program helps fray costs, it represents a fraction of what it takes to purchase, apply and maintain the system.
Mother Frances will be able to subsidize its system, allowing outside facilities to gain access to the technology through Community Connect. Darin Szilagyi, senior vice president and chief marketing director at Trinity Mother Frances Hospitals and Clinics, will help bring in interested facilities that might not be able to invest in that expense.
“I think that the provisions of the law that allow us to subsidize that is really very well thought out because it does create an opportunity to bring an independent physician closer to an integrated system,” he said.
In addition, EpicCare Link allows agencies that aren't currently pushed to adopt EHRs such as rehabilitation centers and home health agencies to gain access to view patients' past histories electronically.
East Texas Medical Center, through its FirstNet Exchange, will provide a means for all health care providers with different platforms — inside and outside of its network — to exchange health information. This service can be provided at a nominal cost to providers.
Providers must set up firewalls and other efforts to ensure that patients' identity and information is protected. Health officials said that with EHRs being implemented nationwide, penalties will be enforced more vigorously for Health Insurance Portability and Accountability Act, or HIPAA, violations.
Hospitals have compliance officers to ensure they are always compliant, and they must undergo validation tests each year.
“We also have very strict protocol determining who gets access to the system and to what areas and only those areas that are appropriate for their view,” said Jeff Pearson, vice president and chief information officer at Mother Frances. “Then we monitor that access to make sure it's appropriate.”
Woelkers added, “Anytime somebody accesses a patient record, we have a record of that.”
Paula Anthony, vice president and chief information officer at East Texas Medical Center, said safeguards are detailed in thick books, which are outlined by HITECH. “We have to prove that we test those safeguards on a regular basis,” Ms. Anthony said. “We have to have very detailed audit logs so if a patient asks, 'who's looked at my record?' – and we get those requests fairly frequently — we have to be able to tell them.”
“Anytime you go from an existing system that is not automated to a system that is automated you've got a period of transition that people are able to migrate it at different levels,” Woelkers said. “Our physicians, I would say are no different than any other populations. They are professionals. We have some that grasped it very quickly. We had others that came along a little slower. I think in general, we have a very positive response from our physicians.”