At Chattanooga-based Digestive Health Associates, the switch to electronic medical records a year and a half ago was by no means a breeze.
Scanning and inputting data from 3-inch-thick medical records on all the practice's patients was time consuming to say the least, group workers say, and the initial startup costs totaled more than $100,000 for the three-doctor practice.
That's on top of a couple of months in which the practice had to cut the number of patient appointments by 20 percent to allow office workers and doctors to learn the new system, office manager Julie Brooks said.
But the savings on overhead costs, transcription fees and the new office efficiency has made the effort well worth it, she said.
"It's a labor-intensive move ... but it's the best thing we ever did," Ms. Brooks said.
While most doctors agree that massive amounts of paper records are costly and cumbersome to their practices, for physicians operating on tight profit margins the huge financial and time investments needed to make the switch to electronic records can be prohibitive.
"There's a smaller margin now for doctors, as far as making ends meet," said Dr. Donald Hetzel, a gastroenterologist with Digestive Health Associates. "That's where the big hesitancy is - it can get pretty expensive."
Under the recently signed federal economic stimulus package, $19 billion has been set aside to encourage adoption of health technology. Doctors' practices and hospital systems could get hefty financial incentives for "meaningful" use of electronic health records, and providers who do not implement a paperless records system in the next five years would face penalties of lower Medicare reimbursements.
In recent years, the state of Tennessee and Gov. Phil Bredesen have directed funding and launched programs to promote health information technology, such as electronic medical records and electronic prescribing of medicines.
An electronic medical records system helps prevent errors and redundant tests by compiling all patient data and medical histories in one place and streamlining a practice's operations, supporters say.
White's Pediatrics in Dalton, Ga., has had an electronic medical records system in place since the mid-1990s, said Dr. Jeffeory White, founder of the practice.
The initial investment of more than $100,000 for the practice has long since paid for itself, Dr. White said. He said he decreased his staff by half when he no longer needed those employees whose sole role was to file and seek out patients' paper records.
"It's saved me so much time and money, it's incredible," he said.
Not everyone is in favor of electronic medical records now, including Sue Blevins, president of the Washington, D.C.-based Institute for Health Freedom, a nonprofit group focused on patients' freedom to choose their health care and maintain their privacy.
She said the patient privacy regulations in the Health Insurance Portability and Accountability Act already are weak and need to be strengthened before all paper records are digitized and thus more easily shared.
"We're not against the technology. I like using an ATM machine," she said. "But when it comes to health care, you're talking about a whole 'nother issue."
A February report from the Institute of Medicine concluded that HIPAA laws should be improved to accommodate electronic medical records.
To date, the definition of a true electronic medical record is still "nebulous," said Russ Miller, senior vice president for the Tennessee Medical Association.
A paper medical record that has been scanned and uploaded into a computer is technically an electronic record, but the key to a meaningful electronic medical records system - one that could improve patient care and reduce redundant tests - is the easy exchange of that data between a patient's various providers, Mr. Miller said.
Over the past few years, Tennessee has awarded 1,830 "connectivity grants" to doctors to help them pay for discounted access to the state's own high-speed broadband Internet connection, which would facilitate their move to e-medical records, said Tennessee Department of Finance and Administration Commissioner Dave Goetz.
The funding for those grants now is exhausted, but stimulus money may help with that, said Antoine Agassi, chairman of the Tennessee eHealth Advisory Council created by Gov. Bredesen.
Health information exchange Shared Health, a wholly owned subsidiary of BlueCross BlueShield of Tennessee, gives physicians access to patients' digital medical information gleaned from insurers' claims data as well as input from a patient's doctors.
The health information exchange now has the medical information for 3 million Tennesseans in its database, said Shared Health President and CEO Jana Skewes
"Physicians tell us they can see at a glance that broader patient view so they can improve their continuity of care," she said.
Melissa Portera, financial manager for Chattanooga Surgical Oncology and Associates, is hopeful that the stimulus package signals an understanding of the burden doctors face in implementing such a system. She estimates it would cost $50,000 to go paperless in her offices and, for now, the option is out of reach, she said.
"At least they seem to recognize that it is an expense, that if the government's gonna require it, they need to help with (paying for) it," she said.