With thousands of dollars in federal incentive payments enticing doctors to use electronic health records, more are considering the move to a paperless system, local doctors and practice administrators say.
But change never comes easily.
"It's stressful for a 56-year-old dinosaur like me," said Dr. Wayne Scott, internal medicine specialist with Galen Medical Group.
The multispecialty Galen group plans to change over to electronic records next year. That will eventually free up three or four exam rooms' worth of space now devoted to stacks of paper medical histories.
"Don't get me wrong, it's going to be great," Scott said. "I'm going to be able to punch a button and know what patient needs what preventive service and when. It will be wonderful, but getting there is going to be a mess."
The federal stimulus package allocated tens of thousands of dollars in incentives to eligible providers who switch to making "meaningful use" - as the Centers for Medicare and Medicaid Services puts it - of electronic health records.
Before long, doctors who don't meet those standards will face reduced payments from Medicare.
While supporters say ditching paper records can improve productivity and save lives by reducing medical errors and improving care, some physicians and office managers are concerned about privacy, functionality and the expense of starting and maintaining an electronic record.
And many are worried about lack of compatibility among practices because of differences in software systems.
Some doctors are putting off the move to electronic health records even at the risk of forgoing incentive payments.
"We're waiting," said Collin Cherry, internist with Beacon Health Alliance. "What I'm anxious to see is that there are [software] systems that have agreement and integration across the field, and that doesn't exist yet."
Family medicine specialists say the ability to link up records systems among practices is where doctors will reap the main benefits of electronic health records.
Chattanooga Family Practice, a seven-doctor group, spent $270,000 on the software and hardware for an electronic medical records and e-prescribing system four years ago. Although the group's doctors agree they'd never want to go back to paper documentation, challenges remain, Dr. Richard Moody said.
Some pharmacies still don't accept electronic prescriptions, and government agencies still are working to allow electronic prescribing of narcotics, he said. Their e-records system still can't "talk to" other physicians' software.
"We're kind of up to the edge of what the technology allows, which is frustrating," he said.
ELECTRONIC HEALTH RECORDS
Providers must meet 20 of 25 objectives to qualify for incentives. Some initial objectives include:
* A percentage of certain types of medical records needs to be online within five years.
* Lists of problems, diagnoses and allergies for at least 80 percent of patients.
* Patient access to test results, problem lists and medication lists.
* Electronically record and chart changes in height, weight and blood pressure for at least half of patients.
* Prescribe medications using electronic transmission at least 40 percent of the time.
Source: Centers for Medicare and Medicaid Services
BY THE NUMBERS
* $44,000: Maximum incentives for physicians who participate in Medicare incentive program.
* $64,000: Maximum incentives for physicians who participate in Medicaid incentive program.
* 1 percent: Reduction in annual Medicare reimbursements between 2015 and 2020 for doctors who don't meet "meaningful use" guidelines
Source: Centers for Medicare and Medicaid Services
A coalition of local hospitals and doctors is working to develop a health information exchange that will link all providers' electronic health records, said George Beckett, health information technology coordinator with the Tennessee Office of e-Health Initiatives.
The exchange eventually will connect to exchanges already up and running in Memphis and the Tri-Cities, he said.
Only a handful of U.S. doctors are using electronic medical records now, surveys show. In 2008, about 17 percent of U.S. doctors had either a fully functional or basic electronic medical records system, according to a study published last year in the New England Journal of Medicine.
But almost 40 percent of those surveyed who were not using an electronic system said their practice intended to implement such a system in the coming years. They cited costs and a fear of early obsolescence as barriers to faster action.
Doctors' hesitations are understandable, said Mark Frisse, Vanderbilt University professor of biomedical informatics and a former member of the Tennessee e-Health Advisory Council.
"[Doctors] understand the importance of doing this right," he said. "These systems will evolve over time. It gets better every year. I would not dive in head first, even with the incentives."
Choosing a vendor who will keep up with the latest technology is critical, said Jack Chapman, a Gainesville, Ga., ophthalmologist and chairman of the group's electronic health care committee. His system dates to the mid-1990s, and the manufacturer has kept up with advances over the years, he said.
Dr. Susan Bhushan of Galen Internal Medicine has been actively persuading more-hesitant doctors in the group about the benefits of electronic records, notably the ability to securely access patient records from home for after-hours calls.
Even with the expectation of $44,000 in incentives for the Galen group over four years, electronic medical records have been a tough sell, she said.
"There aren't real studies that show it improves patient care, and the studies are mixed on whether it improves productivity," she said. "It's hard to convince them to invest in something they may not see a return on in the near future."
But she's convinced savings will emerge over time, although they may be hard to quantify.
"You're saving in the time you're not having to pay extra staff to do things like searching for medical records and searching for papers," she said.