Federal rule tied to electronic medical records panned

January 30, 2010

The federal government has erected a high fence around a pot of $27 billion available to doctors and hospitals that successfully computerize their patient records by next year.

That has sparked complaints around the country—including in Indiana—that the government’s standards are too difficult to meet so quickly.

“It was a typical first swing. It was ridiculous,” said Dr. Tim Story, a primary-care physician at Clarian North Medical Center in Carmel.

The rule was proposed Dec. 30 by the federal Centers for Medicare and Medicaid Services agency. The rule can be altered after a 60-day comment period and will then go into effect.

However, central Indiana doctors and, especially, hospitals have a bit of a leg up when it comes to meeting the hardest part of the rules: exchanging patient information with other health care providers.

That’s because hospitals here are sharing patient records through the Indiana Network for Patient Care, a database operated by Indianapolis-based Regenstrief Institute Inc. And doctors can receive lab reports and quality reports from services provided by the not-for-profit Indiana Health Information Exchange.

“Your physicians in Indianapolis are in better shape that way, because you do have an exchange,” said Wes Richel, an analyst for the Connecticut-based technology research firm Gartner. He supports the government’s high standard, but acknowledged it is a “stretch goal” that will be difficult to achieve.

Electronic swapping of patient records among hospitals and some physicians is occurring all over Indiana, including around Bloomington, Fort Wayne, Lawrenceburg and South Bend.

If those assets prove helpful, Indiana doctors and hospitals could have more success winning subsidies from the government to help defray the cost of their electronic medical record systems, or EMRs.

Those subsidies could reach as high as $44,000 from Medicare alone for each physician, if they are fully ready by 2011 or 2012. Physicians who join in later would receive smaller subsidies. In 2015, Medicare will begin reducing payments to doctors as a negative incentive to adopt electronic medical records.

For hospitals, the incentive payments will hinge on a complex formula based on their number and percentage of patients who pay with Medicare. For a very large hospital, which might have a third of its patients paying with Medicare, the subsidy could top $5 million over four years.


In addition to swapping records, the federal government wants doctors and hospitals to be able to use their electronic medical record systems to prescribe drugs electronically, to track key medical conditions, to report quality scores to the Medicare and Medicaid programs, and to report surveillance data to public-health agencies.

Indiana hospitals and doctors still have plenty of work to do. The electronic sharing of patient records is mainly one-way so far, at least for physicians. They receive reports from hospitals and medical labs, but they don’t send out much information electronically.

They still rely on fax machines, mainly, for that function. Some use e-mail to swap records, but industry experts say it is not secure enough to ensure patient privacy.

“Very few providers currently are tapping into the INPC,” also known as the Indiana Network for Patient Care database, acknowledged Dr. Greg Larkin, chief medical officer at the Indiana Health Information Exchange. Because of that and other challenges, Indiana’s doctors have “only a potential leg up,” he added.•


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