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Saturday, August 14, 2010 – Daily News – 7A Health care law rewards doctors who go digital, penalizes those who don't ORLANDO, Fla. (MCT) — Hundreds of thousands of paper sheets bulge from the weathered charts in the medical office of Dr. Tahsina Atiquzzaman. Patient histories, stress tests and results from colonoscopies are piled in filing cabi- nets, wall shelves and storage closets in her Kissimmee, Fla., private practice, where she sees more than 5,000 patients each year. But the internal-medicine practitioner — and thousands of other doctors — are gear- ing up to go paperless. Atiquzzaman is among those who will be tossing out paper charts and ushering in dig- ital records as part of the health care mile- stones announced last month by the federal government. The new guidelines require doctors to trade paper and pen for mouse and key- board. They must use computerized records in a meaningful way: to order prescriptions electronically or check a patient's symp- toms, diagnoses and medication history. Advocates say so-called "meaningful-use criteria" will not only save lives but time and money. Attached to the guidelines, which doctors must meet by 2015, are carrots and sticks. Physicians who adopt the criteria before 2015 can earn as much as $64,000 during the next five years for their practice. But doctors who miss the deadline will face cuts in how the government reimburses them for Medicaid and Medicare patients. Some experts fear older primary care physicians, already in short supply in the U.S., will close their practices rather than buy expensive software and train their staffs in new technology. Twenty percent to 30 percent of primary care doctors are now considering early retirement because of the guidelines, esti- mates John Littell, a family-practice physi- cian in Kissimmee, Fla., and president of the Osceola County Medical Society. Such doc- tors already retire as young as 50, he added. "We don't want to lose the older doctors, so it's very important we find ways to reach out to them," said Jeanette Schreiber, associ- ate dean for special projects at the Universi- ty of Central Florida College of Medicine. The school got a $7.7 million stimulus grant in April to train physicians and their staffs to use the digital-record-keeping programs. Health care experts have estimated the cost of not having electronic records at near- ly $78 billion a year. That figure includes the cost of sending lab results between hospitals and outside laboratories, duplicating med- ical procedures and shuttling paper charts among doctors. Just cutting out phone calls between doc- tors and pharmacists would save at least $2 billion each year, says a 2005 study funded by the Center for Information Technology Leadership, a nonprofit research organiza- tion in Boston. Instant access to information also could save lives. The first day Orlando Health launched its electronic medical records in 2001, an 82-year-old woman was rushed into the ER unconscious after a car accident with no identification except her driver's license. Before starting to treat her, doctors entered her name into the computer system and found she was on the highest dose of blood thinners from an operation for an abdominal aneurysm a week before. "If we hadn't had that software, we sure- ly would have killed this woman," said Becky Cherney, president of the Florida Health Care Coalition in Orlando. The benefits a patient database brings to public health could be enormous, said Alan Spitzer, a neonatal researcher at Pediatrix Medical Group in Sunrise, Fla. Keeping track of how many children are injured in accidents, such as pool drownings or head injuries, can alert doctors to troubling trends in real time. The cost of purchasing and maintaining the software is steep, and health care providers say stimulus money won't offset the full cost. Orlando Health estimates the MCT photo Internal Medicine specialist Dr. Tahsina Atiquzzaman shows the sliding shelves filled with files that will need to be digitized as part of new health care reform guidelines as medical assistant Nicole Lopera looks on at her office in Kissimmee, Fla. federal incentives may cover only 25 percent of its electronic records costs, said Rick Schooler, chief information officer for Orlando Health. But small practices could have to pay $25,000 to $40,000 for software, computers and technical support. The UCF team is trying to secure loans from local businesses and commitments from software vendors to keep startup costs low until reimbursements kick in. The soon- er doctors adopt the guidelines, the more money they receive. Not everyone is on board with the changes. Some primary care physicians worry that new requirements for reimbursement — such as filling out a questionnaire about each patient — would take away time that should be spent face to face with the patient. "Let's say a patient comes in with dia- betes, high blood pressure and asthma," said John Littell, a family practice physician in Kissimmee and president of the Osceola County Medical Society. "The government wants to see you've done a foot exam, an eye exam, urine tested, et cetera. In the ideal set- ting, we're going to do that. "But the reality is she's also suffering What needs to be electronic before 2015? • A percentage of certain types of medical records need to be online within the next five years. • List of problems, diagnoses and any allergies for at least 80 percent of patients. • An active medication list for at least 80 percent of patients, plus alerts if two drugs don't interact. • Patient access to test results, prob- lem lists and medication lists within three days for 50 percent of office vis- its. • Chart changes in height, weight and blood pressure for 50 percent of patients. • Prescribe medications and receive lab results digitally at least 40 percent of the time. Source: Department of Health and Human Services PAY No more checks to write, stamps to buy, trips to the Daily News office to pay your paper bill, or big payments in advance to get a lower rate Now you can …. SAVE over 17% compared to the regular subscription price! with a painless charge every 13 weeks to your Visa or Mastercard. 13 weeks Home Delivery – only $ Other time increments available also at discounted rates. 530 527-2151 Or use our new online Subscription Concierge service: www.redbluffdailynews.com Click on Subscription Services, upper right on the home page. 24! For more information or to convert or extend your subscription, call from depression and anxiety because her husband lost his job and her son is in Iraq. In a 15-minute appointment, I'd want to focus on the underlying anxiety, not justify the reimbursement to the federal government." Several physicians have voiced concerns about privacy. "I don't want any information from my patients to get out that they don't want out," said orthopedic surgeon Scott Gordon at a recent Osceola County Medical Society meeting. To break into a system such as Orlando Health's, hackers would have to penetrate multiple layers of protection, according to Schooler. Then they would have to know how to log in as a valid user, and then log in to specific applications. Despite fraud and privacy concerns, area doctors are warming to the idea of electron- ic records, in part because of incentive money. More than 400 physicians have committed to working with UCF, according to Karen van Caulil, executive director of the UCF initiative. Atiquzzaman says she'll need the incen- tive money to hire someone to digitize all of her patient charts. She has budgeted $20,000 for new computers and hopes the UCF ini- tiative will save her money on software, which she expects would be another $20,000. "Cost is the biggest obstacle," she said. "I'm waiting to see how much this will be." home-delivered subscription to Convert your Daily News Watch for the PBR insert in Tuesday’s paper on August 24th