Ethnic Physicians Laud Switch to Digital Records
Daunting as it may seem to move from paper to electronic medical records, health information technology could significantly reduce health care disparities in minority and poor populations, agreed doctors at the Sept. 26 Ethnic Physicians Leadership Summit.
Many minorities go to small clinics that continue to use outdated analogue systems. Sixty-five percent of physicians in the country work in clinics of four doctors or fewer. Of these, only 20 percent have gone paperless.
Patients of color who can't take time off from work could benefit from "e-visits," said Dr. Mark Smith, chief executive officer of the California HealthCare Foundation, in his presentation on the overview of health information technology.
Smith lamented that in a world that is increasingly going digital, it is ironic that doctors and hospitals still rely on dead trees to document patient health.
What is even stranger is that digital thermometers are used when patients walk into a hospital; yet, each time they go for a visit, they are asked to fill out the same questions on a clipboard.
"The only service industry that hasn't been affected by the rise of information technology is our industry," Smith asserted, noting: "We are stuck in an analogue limbo."
"Wal-Mart knows more about the box of cornflakes they sold two hours ago than we know about our patients' health," Smith said. "And they know it in real time."
Convinced that if hospitals and clinics went digital, they could save money, prevent duplication in tests and avoid medical errors, the Obama administration decided earlier this year to infuse $20 billion in information technology spending, under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act of 2009.
The money will be funneled through the Centers for Medicare and Medicaid Services (CMS), a federal agency. California stands to get around $3 billion.
Under the terms of the HITECH Act, the CMS will offer incentives to medical practices that use digital medical records technology. Starting in 2011, physicians will get $44,000 to $64,000 over five years for implementing and using a certified electronic system. Congress believes that such incentives will push up to 90 percent of U.S. physicians to make the switch over the next 10 years.
Practices that don't adopt electronic systems by 2014 will have their Medicare reimbursement rates cut by up to 3 percent in 2015.
Molly Joel Coye, president and chief executive officer of the San Francisco-based California Regional Health Information Organization, which hopes to link emergency rooms electronically to major health plans and physicians' offices, said another benefit from going digital would be better tracking of prescriptions.
"Management of medications is the single biggest problem in health care," Coye told the editorial team of New America Media during a recent visit to its San Francisco office.
California physicians have been quicker to move toward the cutting edge of record-keeping technology. Thirty-seven percent of them use electronic medical records, compared to 25 percent in the rest of the nation. But the shift to paperless technology has been largely confined to larger outfits such as Kaiser Permanente, according to the California HealthCare Foundation.
"Only 1.2 percent of prescriptions in California outside of Kaiser and the Veterans Administration are electronic," said Smith.
Panelist David Ford, associate director of medical and regulatory policy at the California Medical Association, described Kaiser's $4 billion software program as "a Cadillac system, which, for most people, is out of reach."
But physicians have other less expensive programs they can choose from, he said, noting that the conversion to electronic records is "probably the single largest investment" medical providers will make.
The United States is "spending a lot but getting low-quality care," said Coye. "The quality of care is even below that of Costa Rica and other countries in Latin America and South Asia."
But that could change as more hospitals and clinics connect to health information exchanges and lessen health care disparities.
"For years we've been talking about disparities in health care. We'll now have the tools to see what's going on," Ford said. "We will have better data on minority communities that we can draw from and form localized solutions."
For instance, if there is a high prevalence of asthma in a particular region, researchers will be able to track patterns and isolate the impacted community.
Low-income Americans and people of color continue to experience disproportionately higher rates of disease, fewer treatment options and less access to health care, according to a report released in June by the Department of Health and Human Services.
The report notes that 48 percent of African-American adults have a chronic disease compared to 39 percent of the general population. Fifteen percent of African Americans and 14 percent of Hispanics develop diabetes, compared to 8 percent of whites.
Ford noted that in the Tongan community in the United States, there is a high incidence of cervical cancer; yet, little research is ever conducted among that population to eliminate disparities.
Mary Pittman, president and chief executive officer of Public Health Institute, warned that while high-tech represented a "great opportunity to advance practice, it should be treated as a floor and not a ceiling.
"The current focus is on physicians and hospitals," she said at the ethnic physicians' summit. "But patients' families and other caregivers have to benefit as well."
Some physicians at the summit worried whether the federal government would renege on its promise to reimburse them, even if they proved they were putting their digital systems to "meaningful use," a requirement to qualify for the reimbursements.
They recalled that some physicians who participated in the 2007 Physicians Quality Reporting Initiative either never received the promised bonuses or received smaller amounts.
"The federal government wants to do (the conversion to electronic records) because it will ultimately reduce costs," Ford said.
The ethnic physicians summit was sponsored by the Network of Ethnic Physician Organizations and the California Medical Association Foundation.