As Medical Charts Go Electronic, Rural Doctor Sees Healthy Change
Published: April 10, 2009
Fabrizio Costantini for The New York Times
Fabrizio Costantini for The New York Times
A year ago, she switched her 3,000 patients from paper charts to electronic health records, a core feature of most plans for healing the nation’s ailing health system. Now, working with computers and printouts, her staff of part-time nurses and shared front-office workers has more time to help her meet the needs of patients.
“I’ll never go back to the old system,” said Dr. Brull, 37, who runs a solo practice in Plainville, Kan. “I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.”
Patients are appreciative, too. Kagay Wheatley brings her 97-year-old neighbor, Charlotte Hayes, to Dr. Brull for blood tests every few weeks. “We do not have to sit and wait while the nurses search for the records,” said Ms. Wheatley, a retired school board aide who is also a patient of Dr. Brull’s. “They find the information right there on the computer, and when we leave, we get a printout of what we did and what she said.”
About 42 percent of active family doctors have installed some
type of electronic health records, according to surveys and
estimates by the
Medical centers like the new 24-bed critical-access hospital in
“The use of electronic health records and being able to transmit
X-rays allows us to be in contact with the whole world,” said
Chuck Comeau, a hospital board member who is chief executive of
Dessin Fournir, a national furniture design company that moved
its head office to
Even so, 8 in 10 of all American doctors still labor in a world of paper. And some doctors said they encountered upsetting setbacks when they tried to switch to electronic records.
Michael Ferris, a 33-year-old emergency medicine physician in Parsons, Kan., said he had to give up his solo practice after he had invested $38,000 in software for systems that kept crashing and thwarting his attempts to send out electronic bills. “I was spending as much time trying to fix the computer and the billing as actually seeing patients,” he said, “and neither process was generating any revenue for me.”
Now, as director of the emergency room at the
Information technology for health care is a $20 billion section of the $787 billion economic stimulus package President Obama signed last month. But only part of the new I.T. financing will help individual doctors who convert to electronic health records, said Dr. Steven Waldren, director of the center for health information technology at the academy of family physicians. Those in rural and underserved areas should benefit the most.
“For the vast majority of physicians, there is not going to be upfront money to purchase electronic record systems,” Dr. Waldren said.
Dr. Brull, who grew up in
They have 8,000 patients in all, including some from neighboring
counties. The three doctors together cover a lot of ground:
delivering babies, performing
colon cancer checkups
and staffing the emergency room at the hospital. They refer
patients who need intensive care or a specialist to the
The three are the only doctors in
Dr. Sanchez is a deputy coroner and the ambulance service director and is taking a turn as hospital medical director. Each doctor is a solo practitioner with a separate tax ID. “At the end of the day, our paychecks come from our own business, our own patients,” Dr. Fisher said.
They are informal partners, and cover each other’s patients. “We do everything on a handshake,” Dr. Brull said.
It took five years for her to persuade the other doctors to make the switch to electronic records. “Dan was our holdout,” she said.
Dr. Sanchez explained that, at first, “I was not sure I saw the benefits. Now I’m a very big proponent of it. I’ve gotten to the place where I prefer to get an electronic chart over a paper chart.”
Costs, like those to have his dictation transcribed, are down 75 percent. “The volume of paper flowing around has dropped dramatically,” he said. “That alone paid for half the cost of the software in the first year.”
They selected a medium-priced system (from e-MDs, based in
The electronic system helps Dr. Brull with just about every part of her practice. She keeps close watch on 250 patients with high blood pressure and 180 who have diabetes. She pays special attention to people who have both problems, summoning them for blood tests every six weeks
The computers make it easier to keep track of them. “We can run a computer report on diabetics who haven’t had appropriate lab work, or people who haven’t had a wellness exam in 10 months or did not have a flu shot,” she said.
When she leaves the office to see patients at a nursing home, she said: “I have access to my notes on each one on the laptop. It takes out the guesswork.” For people who pick up their pills at Walgreens or Wal-Mart, the software forwards an electronic prescription. “We are working to persuade the mom-and-pop pharmacies to get on that system,” she said.
Dr. Brull said she expected to recoup her investment in five years, perhaps sooner. It did not hurt that two other family doctors left the community last April. “All of a sudden, three or four thousand patients had no doctor,” she said. “We took on a large volume. If you work harder, you get more money.”
Still, she said she shared the frustrations of many physicians who say the insurance companies often seem to use delaying tactics to avoid paying for care, even when the bills are delivered to them by computer. “I feel like I spend a lot of time justifying what I do and chasing the dollar,” she said. But despite such concerns, she said, she is too busy to have much time left for complaining. “I am not a very good pessimist,” Dr. Brull said.