When your doctor writes a prescription, does he use a paper pad, or a PDA or a laptop?
Is your chart a manila folder stuffed with handwritten notes, photocopies and faxes, or a record in an electronic database?
And here’s the real tricky one: If someone asked your doctor how many of his patients have asthma, how many are taking Lipitor, or how well he’s controlling his diabetic patients’ blood sugar levels, would he ever be able to answer the questions?
With a good electronic medical record (EMR) system, used to its full capabilities, he should be able to answer. Some doctors’ practices and community health centers are doing it, at least to some extent.
Now, as required by legislation passed last year, the R.I. Department of Health is surveying physicians across the state to find out just how widespread EMR use is, what kinds of doctors are using them, how they’re using them, and what’s holding up the rest.
The survey went live on the department Web site on Jan. 2, and e-mail and paper mail notices were sent to the 2,125 doctors in active practice in the state, with two reminders being sent this month before the survey closes Feb. 29.
For those who have already gone electronic, there’s an immediate incentive: Blue Cross & Blue Shield of Rhode Island, which has set up a plan to raise primary care doctors’ pay over several years, is giving half the raise only to those who use EMRs.
And to qualify for the EMR pay, doctors have to successfully complete the state survey.
Not surprisingly, of the 609 doctors who had replied as of Jan. 30, a disproportionately high number reported using EMRs: 337, or 55.3 percent, of respondents (15.9 percent of the total), according to a Health Department fact sheet. More than a quarter of the respondents so far were internists – 10.7 percent in family medicine, and 11.2 percent in pediatrics.
“It is important to remember that these data are preliminary,” the fact sheet notes. But given the Blue Cross incentive and the fact that doctors have been told that if they don’t respond, they will be presumed not to be using EMRs, officials also believe a large share of those using EMRs did respond in the first wave.
In an interview, Dr. David R. Gifford, the state health director, said the results so far seem roughly in line with how many doctors are using electronic records nationwide. The state has not set targets for EMR adoption yet, he said, but clearly the more, the better.
“Our goal is to get as many physicians adopting electronic medical records as possible,” Gifford said. But he stressed that “it’s not just buying the software – it’s using the functionality of the software.”
Doctors should be writing electronic prescriptions, for example, Gifford said, and they should use EMR systems to generate reminders for patients who need Pap smears or mammograms – as veterinarians seem to do with ease when it comes to pets’ rabies shots.
Moreover, physicians should using EMRs to ensure they are giving each person the best possible care, prevent errors and track patients with chronic conditions, he said.
“We don’t support converting the inefficient manila folder into an inefficient electronic record – we want to improve quality,” he said.
A “handful” of doctors across Rhode Island are already using EMRs that way, and some community health centers are doing very good work in this field as well, Gifford said.
The fact that Blue Cross is providing financial incentives to do so – because, like the Health Department, it’s defining EMR use as actually making the most of the software – is a big help, Gifford added, and “I think other insurers should adopt what Blue Cross has done, and I think we should encourage them to do this.”
Quality Partners of Rhode Island is working with the state on the project, helping design and implement the survey and collect and analyze the data. Blue Cross also has been involved, Gifford said, and other public reporting systems across the country were evaluated.
Doctors will get data feedback reports by March 31, and aggregate figures will be made available to the public, but there won’t be a list of EMR users published just yet, Gifford said – whereas a list of e-prescribers is posted on the Health Web site, www.health.ri.gov.
Next fall, or at the latest early next year, a second survey will be done, and those results will be made public in detail, Gifford said.
In the meantime, he said, businesses and individuals should be asking their doctors where they stand on EMRs, and checking the e-prescribing list to see if they are doing that at least.
“We utilize computers in every aspect of our lives, and health care is one of the most important aspects of our lives,” he said. “Not to utilize the power of computers [for it], I think, is a mistake.” •
