Apr. 5--With 10 offices and surgery centers in the Richmond region, it made sense for Virginia Urology to invest in electronic health records.
"Patients would show up in a different office because they found other offices more convenient," said Dr. James Ratliff, a physician with the practice.
Faxing or hand-delivering charts wasn't very efficient or convenient, he said.
The practice went to electronic records in 1992. They have since upgraded and added on. Their current system alerts doctors to possible drug interactions. It allows X-rays, images and other patient information to be accessed from office or hospital.
"I think most practices in two years will have electronic medical records," said Ratliff, also board chairman for MedVirginia, a privately run health-information technology agency.
"It's not easy or it would have happened a long time ago," Ratliff said.
In recent years, emphasis on electronic health records has skyrocketed, driven, in part, by federal investment and by improvements in technology.
The federal investment includes grants announced in August for hospitals, doctors' offices and other providers to implement electronic health records.
The money includes:
-- $598 million for establishing 70 health-information technology regional extension centers to provide technical assistance to private providers implementing electronic health records; and
-- $564 million to states and other entities to support development of networks that allow different systems to share information.
The Virginia Health Quality Center and partners -- the Center for Innovative Technology, Community Care Network of Virginia and the Medical Society of Virginia -- won a $12.4 million federal grant to develop one of the 70 regional extension centers.
"When we wrote the application, we put out a call for interest among physicians," said Dr. Sallie S. Cook, chief medical officer for the Virginia Health Quality Center.
"We got almost 1,000 physicians saying they are very interested in getting this technical assistance."
In addition to those funds, work-force training grants are available to help colleges and universities train people to work with health-information technology.
And billions of federal dollars will be paid to providers enrolled in the Medicaid and Medicare programs who make "meaningful use" of electronic medical records in patient care. Provider offices are eligible for $44,000 grants over five years.
"There are a lot of moving parts right now," said Michael Matthews, CEO of MedVirginia.
"If you think about it, the endpoint of all of this . . . is better patient outcomes," he said. "Electronic prescribing is part of meaningful use. They expect you to pass a threshold that a certain number of your prescriptions be sent electronically and that you can do medication checks."
And it is not just having something that "plugs in inside the four walls of your office" and is unable to communicate with other doctors' offices and hospitals.
"Health care is about being able to connect to all the other people in the system that are involved in the care processes -- specialists, hospitals, labs, pharmacies and so forth," Matthews said.
Area hospitals are at various stages of integrating electronic health records.
Southside Regional Medical Center in Petersburg has had a McKesson system in place for about 18 months.
"We don't have to run to get the record from the back of the office like we used to," said Melinda MacIntyre, operations manager at Southside Regional.
At area Bon Secours properties, staff members are being trained on the Epic health-information system being implemented at hospitals and affiliated practices this year.
The target date is this month at Memorial Regional Medical Center and Richmond Community Hospital, in August at St. Mary's Hospital and in January for St. Francis Hospital, Bon Secours spokesman Michael Spine said.
"No paper order sets. No handwritten stuff. Everything is entered into the computer," Spine said. "We have a training center at the Arboretum, and we are going to run through every employee."
The VCU Health System has had components of electronic medical records for more than 20 years.
"We had an old, old system even before I started working here, which was about eight or nine years ago," said Dr. Colin Banas, assistant chief medical information officer at VCU Health System.
In 2004, the health system upgraded to a new electronic system at a cost of $57 million that provided a lot more possibilities. A year ago, the health system began requiring doctors to submit their patients notes electronically. In pilot-testing stages is a hand-held device that enables users to access information.
"In the last year or two, we have been ramping up on all fronts of what the public views as more typical electronic records. When all this information starts to populate the electronic record, that is when we start to see a benefit," Banas said.
"If a patient has dia-betes, we want the electronic record to help us provide appropriate evidence-based care," said Banas, who believes a drop in cases of deep-vein thrombosis -- blood clots -- at the hospital is partly because of drug alerts in the electronic health records system.
At Southside Regional, they also are testing the boundaries of the technology. The hospital, part of the Tennessee-based Community Health Systems chain, is testing coding and billing software that can go through doctors' notes and look for keywords and generate a bill.
"It highlights certain terms and words to bring to the coder's attention. It's called computer-assisted coding," said Kimberly Galloway, health-information management director and assistant facility privacy officer at Southside Regional.
HCA Inc. uses the Meditech system, said Dr. Jonathan B. Perlin, president of clinical services and chief medical officer of Nashville-based HCA, the nation's largest hospital operator. HCA has six hospitals in the Richmond area.
VCU's Cerner system, the Epic system at Bon Secours, the McKesson system at Southside Regional and the Meditech system at HCA can't "talk" to one another.
Ratliff, of Virginia Urology, sees patients at Bon Secours and HCA hospitals.
"I can get into each of those [hospital systems'] records systems," Ratliff said. "But those two systems aren't talking to each other, and it's still a bit of a separate process to get into those."
That lack of interoperability is being worked on. In the meantime, some have found a way around it.
Dr. Aka Gvakharia of Cardiology of Virginia, who sees patients at several area hospitals, said he uses a $39.95 application called LogMeIn Ignition on his iPhone to remotely access his work or home computers.
"The problem for me is, most of my work is during nights and weekends," he said. "I don't have the luxury to pick up my phone and have the nurse fax the records."
Using LogMeIn Ignition, he can fax the records to himself or to the hospital he's heading to.
"It has really helped me several times," Gvakharia said. "There are alternatives. This one works for me."
The federal plan to get different computer systems talking to one another is through health-information exchanges.
"The idea is, in the future, just as if a person might have a Macintosh and another have a PC, they can both exchange information over the Internet," said HCA's Perlin, who is leading a national committee on health-information technology standards.
"We don't need a single system. Just like I can send an e-mail on a BlackBerry and get it on an iPhone," Perlin said.
MedVirginia's Matthews said Virginia is expected to get $11.6 million in federal dollars to develop an exchange.
"It's a four-year program. It's neither a grant nor contract," Matthews said. "It's a cooperative agreement."
The state's Health Information Technology Advisory Commission will oversee that effort, said Matthews, a member of the commission.
The state, he said, should have completed preliminary plans for the exchange by the fall. The plan will then go to a health-information technology office within the U.S. Department of Health and Human Services for approval.
Once in place, the state network would be connected to a national network, where systems will be able to talk to one another.
"Nobody would expect them to dismantle [an existing system] and put in a new system that is interoperable," Matthews said.
"That is what a health-information exchange does," he said. "It would be able to connect to different kinds of platforms, be able to extract the information that's required to be exchanged and then provide a utility that allows the physician to receive that information in a secure, confidential way."
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Contact Tammie Smith at (804) 649-6572 or TLsmith@timesdispatch.com.
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