Fayetteville firm advocates patient-owned health records.

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Thanks to new federal incentives for health care providers to adopt electronic medical records, a Fayetteville company's time may finally have come.

Though US Health Record has offered electronic health records for more than a decade, the medical industry has been reluctant to adopt because implementing an EHR system requires a work-flow overhaul.

"When all the reimbursement rates were being cut back, the last thing they wanted to do is go buy another technology when their costs were going up and their reimbursements were going down," said Scott Bolding, chairman and CEO of US Health Record.

But governmental incentives, and eventual penalties, for doctors and hospitals should finally spur the medical industry into action.

"Now that there's money out there, it's changed the game," Bolding added.

Each doctor stands to collect a $44,000 tax rebate for going electronic while hospitals can earn at least $2 million from the American Recovery & Reinvestment Act.

David House, chief information officer of Baptist Health of Little Rock, expects his hospital to receive about $15 million in stimulus funds. But that number falls far short of his projection of the cost to implement an EHR system--$40 million to $60 million over the next 10 years.

Baptist is evaluating several EHR vendors and hopes to select one by the end of the year.

The shot clock for stimulus funds extends until January 2011. If hospitals and clinics meet certain guidelines, which have not yet been finalized, they will get funding to bankroll the EHR changeover.

If they haven't met the incipient guidelines by 2015, penalties will ensue. The penalties aren't established yet either.

On the Web

Unlike some electronic health record systems, US Health Record designed its Web-based platform to be able to share a patient's health information with any hospital or medical clinic with Internet access, Bolding said.

Although many hospitals can share patient records within their own networks, Bolding said Hurricane Katrina demonstrated why intercommunication isn't enough.

"All these patients that ended up in these various wards down in New Orleans, they showed up and they didn't have their pill bottles. They didn't have their medical history. Their pharmacies were closed. There was no way to get access to that information," Bolding said.

"So many times the physicians just had to start over."

Starting from scratch forces doctors to perform scans and tests that would be unnecessary if the patients' records and medical histories were available. "The medical industry is one of the industries that is really far behind in terms of its use of technology to manage data," Bolding said.

Costs of Benefits

Implementing an EHR system, experts say, is not unlike changing a tire of a moving vehicle. A hospital can't shut down while training physicians in new processes.

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The biggest difficulty is "just getting all the appropriate people that are already busy with their jobs available and working on the project as much as they need to," said Kari Cassel, chief information officer for the University of Arkansas for Medical Sciences at Little Rock.

"When you begin to change the way they do their work, that's challenging," House said. "And in [Baptist Health's] case, we not only have to change the way our employees do work, but we also have business partners called physicians that we have to make sure when we're making these changes that we enhance their ability to do work and not take them backwards."

While changing the way physicians treat patient data presents several obstacles, the benefits of an EHR system will pay off, Bolding said.

US Health Record claims its comprehensive EHR will save patients money by sparing them from redundant tests and scans. Everything from dental records to X-rays to allergies to MRI results will be stored in the file.

Bolding said US Health Record's EHR differs from some competing products in that the patient controls the record and has access to everything in it.

Cassel said UAMS already uses electronic health records. In the past, those records have been accessible only to UAMS caregivers and referring physicians. This week, though, the hospital is making patient information available to patients.

So far, UAMS patients can only access lab results. Eventually, the menu of data a UAMS patient can access will be much more populated, Cassel said.

"I would like to see all the data available there because, really, at the end of the day, the data belongs to the patient anyway," Cassel said.

Cassel said the government mandate of EHRs will ultimately improve patient safety and quality of care.

"As you roll out a very functional electronic medical record, you get more structured data," Cassel said. That data, she said, will enhance a hospital's ability to deliver health care.

For example, if a certain form of treatment of a disease begins to show promise, a hospital can perform a search and flag all cases that can benefit from the treatment.

A hospital can also use the data to save time.

For example, US Health Records' product allows a hospital or clinic to load a medical history questionnaire and an informational video into the EHR of a patient recently diagnosed with diabetes. The doctor and patient can then correspond back and forth through the EHR if the patient has questions.

Bolding said that he and US Health Records co-founder Rick Roblee are working with Willow Creek Women's Hospital in Johnson to provide babies with EHRs. The company will send the mothers reminders via e-mail or text message when the baby is due for immunizations.

The system will also notify Willow Creek if a mother misses an immunization.

Hospitals and clinics are the actual purchaser of US Health Records' EHR product, which Bolding said is a total of about $2,000 per year. The patient is never billed directly by US Health Record.

Research

The most substantial effect on the medical field will likely be on the research side of the industry.

"The research piece is huge," Cassel said.

Bolding said US Health Record patients can choose to allow researchers to use data from their electronic health records, excluding personal information.

Access to a wealth of searchable data would be a huge leap forward for medical research.

"You can't do any data mining on a paper chart," House, of Baptist Health, said.

Even when a doctor dictates a chart using speech-recognition software, the text format doesn't allow for any data mining.

Bolding is optimistic that a technology he helped pioneer will one have resounding effects on medicine.

"I really think," Bolding said with conviction, "that this technology will lead to the cure of cancer someday."

By Jamie Walden

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