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Electronic Medical Records: Rx for Coordinated Care

Federal money -- and looming penalties -- help convince more NJ physicians to computerize their patients' charts.

The move by New Jersey doctors to using electronic medical records is gathering speed, as federal subsidies and looming financial penalties are expected to encourage physicians to go digital by 2015.

Thus far, the federal government has given the state's doctors $38 million in subsidies to help cover the expense of converting patient records from paper charts to electronic medical records. Up to 27 percent of the state's doctors have made the move, according to Colleen Woods, New Jersey Health Information Technology coordinator. She estimates that by 2015, when Medicare plans to impose financial penalties on doctors who have not digitized their records, that figure could exceed 80 percent.

New Jersey's shift to EMR has been hampered because the majority of physician practices are small, with one or two doctors, making it difficult for them to commit the time and money required to adopt technology. Even so, Woods said that federal officials "when they look across the nation, tell me there is more collaboration [among healthcare stakeholders] here than in any other state. We are all working together."

Woods' mission is to achieve the goal of each patient having an EMR by the end of 2014. "That means we have a long way to go particularly in our physician offices," she said. More than 70 percent of New Jersey's 33,000 physicians work independently, so the challenge to actually invest and implement EMR is a challenge.

The work started in 2011. "We have done a lot in the first year, and we have a lot of work ahead of us," Woods said.

Medicare has announced that beginning in 2015, physicians who have not converted to electronic medical records will have 1 percent of their Medicare reimbursement withheld by the government.

Congress appropriated funds in the 2009 stimulus law to provide grants to individual doctors who could demonstrate that they were making "meaningful use" of EMR. Another federal grant funded the creation of NJ-HITEC, based at the New Jersey Institute of Technology in Newark, which is helping New Jersey's primary care doctors navigate the hardware, software, and office management decisions they need to make to adopt electronic medical records.

Ron Manke, regional director of NJ-HITEC, said 5,200 primary care physicians had signed up as of November 15. So far, half of them are now using EMR software in their offices, and 250 have demonstrated meaningful use. Woods estimated that a total of 8,500 New Jersey physicians are using EMR, including primary care and specialists.

The federal government's EMR program "is really focused on two things: to improve healthcare quality and reduce healthcare costs, and we're building a nationwide structure," to accomplish those goals, Woods said. Each state "is building an infrastructure where we can share data, report data, measure data, and start to solve these things that we talk about every day."

Eventually all the systems will connect, providing doctors, hospitals, long-term care facilities, ambulance squads and physicians with immediate access to patient medical records. A major goal, Woods said, is to reduce medication errors.

In addition to the work being done in doctors' offices, several regional health information exchanges are being created throughout the state so hospitals can share information among themselves and with other healthcare providers, such as labs, imaging centers and long-term care facilities. The HIEs will be the hubs where information is exchanged among providers.

Earlier this week, Health-e-cITi-NJ, announced its eight member hospitals in northern New Jersey and other providers will go online over the next month and begin to exchange information. Mike Relli, vice president of IGI-Health, the software provider to Health-e-cITi-NJ, said even physicians who have not yet installed EMR in their own offices will have access to the patient information being gathered online by the HIE.

For instance, a doctor who has not yet implemented EMR will be able to "go online and find out about the patient's experience in the hospital," Relli said. This is a limited version of EMR, which we are calling 'EMR lite', it's almost a starter EMR system," Relli said. It will enable the doctor to have some of the benefits of EMR even before that physician has installed a full-functioning EMR system.

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