MEDICAL RECORDS; HOSPITALS STRUGGLE IN TECHNOLOGY TRANSITION TEDIOUS TASK the Slow Process of Going Paper-to-Pixel Is Trickling into Local Hospitals and Offices. OBAMA'S OFFER Smaller Practices May Not Be Able to Wait for a Federal Reimbursement. LOCAL LIMITS A Northeast Florida Group Is Working on a Regional Information System, but Needs More Funding and Support

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Doctors and nurses across Northeast Florida are trading in pens for keyboards as health care providers make the slow, expensive and often tumultuous transition to electronic medical records.

Most Jacksonville area hospitals are using a computerized record-keeping system or, if not, are working toward that goal. Physician practices lag a bit behind, but the number moving from paper to pixels is accelerating.

Will that transition speed up, what with President Barack Obama's $19 billion effort to improve the use of information technology in health care? And will that technology, once implemented, allow local providers to share patient medical records, thereby demolishing one of the biggest stumbling blocks in modern health care?

The answer to both questions, health care administrators and information technology advocates say, is the same: probably not. Unless there are significant changes locally and nationally.

"This, from a technological standpoint, is like John F. Kennedy saying, 'By the end of this decade, we will put a man on the moon,'" said Keith Justice, an oncologist/hematologist who heads Flagler Hospital's cancer center. "Right now is 1962 and we need 1970 material."


To understand the challenges that lie ahead, look no further than the St. Augustine hospital. In October 2005, Flagler leap-frogged ahead of the majority of U.S. hospitals when it replaced patient charts with Internet-ready laptops that could be wheeled from room to room on carts.

One of the first snags developed over what to call the devices. Administrators trained staff members to call them WOWs, as in "wireless on wheels," after the initial acronym -- COWs, as in "computers on wheels" -- was deemed potentially offensive to larger patients.

But the hospital's IT department had an even bigger problem on its hands. While the effort successfully integrated the more than 30 specialties offered at the hospital onto a single software program, it meant doctors had to start keeping two sets of medical books.

That's because Flagler, like most community hospitals, is staffed by physicians who have privileges to practice but aren't employed by the hospital. Many have their own electronic medical record systems, or EMRs, at their private offices, but those systems operate separately from the hospital's.

"They don't talk to each other," Justice said, adding that if he wants to send a patient's records to the hospital, he has to do it the old-fashioned way -- print it out and fax it.

It is these small hassles that health care IT advocates say add up to a lot of waste. When the potential to reduce medical errors is factored in, the electronic switch could save health consumers billions every year, proponents say.

Nationwide, the $20 million to $100 million price tag on hospital EMR systems has slowed adoption rates. Fewer than one out of 10 hospitals have even a basic EMR system, according to a survey of more than 3,000 hospitals published online last week by the New England Journal of Medicine.

In an adjoining editorial, one of the study's authors wrote that although Obama's plan was "of the type rarely produced by our famously incremental federal government," it faces "huge challenges" -- primarily in the form of high maintenance costs and privacy concerns.

The author was David Blumenthal, the man recently tapped by Obama to coordinate the national IT makeover.


Of the $19 billion, $17 billion is targeted toward financial incentives for doctors and hospitals to buy EMR systems. Physicians who adopt a system and prove "meaningful use" of it by 2011, for example, can receive $44,000 in bonus Medicare payments over five years. In 2015, financial penalties will start for doctors and hospitals if they haven't done so.

Brian Klepper, a Jacksonville-based health care consultant and IT advocate, said he doubts smaller physicians practices can wait so long to get reimbursed on their EMR investment. …


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