Wired MD: NJ Plugs Into Funding to Digitize Patient Records

Beth Fitzgerald | February 10, 2012 | Health Care
Medicaid providing $40 million to entice initial investments in electronic medical records

New Jersey announced a milestone Thursday in the long journey to convert the state’s hospitals and physicians to electronic medical records: Nearly $40 million in federal incentive funds is flowing this week from Medicaid to the first 70 healthcare providers in New Jersey to go digital.

Over the next decade, state officials estimated that 3,000 providers would receive up to $500 million in Medicaid incentive payments to help defray the cost of installing the computers and software that will maintain patient records — prescription medications, lab tests, exams, surgery — in digital files that ultimately will be accessible via the Internet, anywhere in the world.

That sounds like a lot of money, but Colleen Woods, who heads the state Office of Health Information Technology, said the Medicaid incentive payments, authorized under the 2009 federal stimulus law, fall short of covering the full cost of the investment that hospitals, doctors, labs and pharmacies have made — and will continue to make — in electronic medical records.

hospitals incentives

Woods and healthcare executives who announced the Medicaid incentive payments said the real payoff isn’t financial but clinical, and will appear in the form of fewer medication errors, unnecessary tests and procedures and hospital stays, and improved health outcomes.

New Jersey is building a wired healthcare world designed to link hospitals, doctors and patients no matter where they happen to be in the state. Woods predicted New Jersey will lead the nation.

“We’re hoping that by the end of 2012, given the investment and the technology infrastructure that is being built, that we in New Jersey will be the first state that will be able to exchange clinical information on a statewide basis,” she said.

The goal is for every New Jerseyan to have a personal electronic medical record by the end of 2014.

The state has created five regional electronic health information exchanges, where doctors, labs, hospitals, pharmacies and other healthcare providers exchange information on a regional basis. The next step is empowering these regional organizations to link together into a network that weaves the entire state together.

Healthcare offices incentives

Other states have also built regional healthcare data exchanges, Woods said, “but none to my knowledge is covering them across the state, so you see big white spaces in Texas and California where there just isn’t the capacity to share data. New Jersey, perhaps being a small state, and because of all the investment that our providers have made, we have the potential to be the first. That is really our goal and what we are striving for.”

The incentives payments to help healthcare providers are being paid by Medicaid, but the value of switching to digital medical records benefits all the patients who use that provider, not just the Medicaid beneficiaries.

Valerie Harr, who heads the Medicaid program in the state Department of Human Services, said digital medical records will play a key role in the state’s efforts to improve the health of the state’s more than 1 million Medicaid members.

“Medicaid recipients frequently have chronic illnesses and go to a variety of hospitals and physicians,” Harr said. Switching to digital medical records “will enable the providers to coordinate and improve the quality of care for our Medicaid beneficiaries and improve the patient experience.”

Dr. Vinnakota Rao is a pediatrician in Warren who switched to using electronic medical records nearly six years ago. “The interesting thing is we have all the data about the patient in the computer. It tells us who needs what — who needs an immunization, who did not come back for a follow up visit, everything at the touch of a button.”

Digital technology has reduced administrative overhead, Rao said. “We used to have something like nine staff members, and now we have five and we can perform infinitely better. The quality of care is absolutely different.”

Amy Mansue, president of Children’s Specialized Hospital in Mountainside, said electronic medical records have enabled her system to reduce medication errors. Of the more than 600,000 medication doses dispensed by the system each year, the number of misdoses was 31 in 2010, then fell to 13 in 2011. “And that was all about EMR,” she said.

The computer “prompts you to make sure you are giving the dose at the right time. It doesn’t let you move forward to put a note in unless you have given the dose. All those things that a nurse would have to remember are right there in the EMR. This has allowed us to really improve patient care real time,” Mansue said.

Tom Bartiromo, vice president of Barnabas Health, said digitizing patient records “is a platform that creates the conditions for the right things to occur.” The technology provides “improved communication and ultimately a complete record of the patient” from one care setting to another.

Woods said reducing medication errors is one of the most dramatic benefits of electronic medical records. “Deaths caused by medication errors in the emergency room now exceed suicides and gunshot wounds across the nation. So the first thing New Jersey is going to exchange, the first set of data, will be current medication histories across the state.”

Dr. Tom Ortiz, a family physician whose Forest Hill Family Health practice in Newark treats a large population of chronically ill patients, said he adopted digitized records a dozen years ago, “before this became a popular thing, just because of the sheer volume of paper that we were going through in the office. We found it was a significant way to streamline the operation to be more cost effective.”

Forest Hill has also been certified as a patient centered medical home by meeting national standards for preventive care and care coordination, and he is optimistic that progressive practices like his will see increased reimbursements as they demonstrate an ability to reduce over utilization of healthcare system, and improved quality of care.

“We want to see a change in the way the healthcare system is financed and the way primary care doctors get paid because the current system doesn’t work,” Ortiz said. Healthcare “is 15 years behind every other industry when it comes to use of IT and the sharing of information. I can be right down the block from a specialist that I am working with, and I can’t get a report real time” via electronic communication. “I am glad to hear the state will have a statewide network we can work across.”