As a doctor, there are many benefits to paper records. It is faster. Everything fits on 2-4 sheets of paper, and there is no risk of electronic hacking that might expose a patient’s personal information. So why change? If you remember a little law passed years ago called HIPAA, the answer is mostly in the P, but also in the A. HIPAA stands for Health Information Portability and Accountability Act. The goal of this act is to make doctor’s records and information about each patient portable. The hope is that with other doctor’s data available to all doctors using the system, there will be less room for redundancy in testing, less risk of drug interactions, and a greater ease of seeing the whole picture so as to prevent early disease and death to patients.
For the doctor, failure to implement an electronic health record will make it virtually impossible to communicate effectively with other clinicians, and eventually, will by default prevent those doctors from participating in insurance plans offered by the affordable care act. In fact, in order to participate in the plans, each doctor will have to show that they are using their electronic health record in a meaningful way to achieve this goal of portability to other doctors and to the patients. Doctors need to be able to communicate with you and other medical providers securely, and so a patient portal with user name and password will be required. On the upside, patients can go right on the portal and access the information, prescriptions, receipts, summaries of the findings, etc, whenever they want!
Without having a portable electronic medical record, doctors will not be able to take many medical plans in the future, so unless they want a self-pay only practice, it is a necessary step. Also, the part of HIPAA that makes every doctor nervous is the A…accountability. As clinicians, are we doing what we say we are doing? And, are the tests we choose to run necessary to help us make good clinical decisions about our patients, or are we simply doing extra tests because we need to pay off our cool new machine. Having transparency in our record keeping allows the government and insurance companies to analyze the data we input to ensure we are following the rules of the contracts we have signed. Of course, like the legal tax code, the system is complex, and clinicians are worried they will fail to comply not because of fraud (the intent to do wrong knowing the specific rules), but rather abuse (over charging the system because of ignorance of the law).
The affordable care act is expensive, and part of the government’s plan to finance the care is to collect revenue from doctors committing not only fraud, but also abuse. It is expected that about 40% of doctors are unknowingly, ignorantly, committing abuse, and with increased audits, the government is making about $19.00 in revenue for every $1.00 they spend investigating. Electronic health records make it easier for them to investigate at a lower cost. With the implementation of ICD-10 coding (we have been using ICD-9 coding), we can expect collections to soar as doctors code incorrectly. There are 17,000 ICD-9 codes doctors have to get right. When ICD-10 coding starts, there will be 141,000 codes the busy doctor will have to try to get correct.
For instance, if the patient comes in for itchy eyes, the doctor will need to ascertain which eye is worse, how long they have had it, what makes the symptoms worse, and what they have done to help it. Then, the doctor must do the exam, keeping this in mind, and proving there are medical signs that relate to this chief complaint. Assuming there are, the doctor can then find a specific code that links the many aspects of the complaint to the various signs found. After going through a complexity rubric, the doctor will need to select a level of care given in his procedure code that links to the severity of his diagnostic code. If he does not keep every element of the rubric in mind and accidently codes one level too high, he has committed abuse, and if discovered, can owe the government penalties the thousands or hundreds of thousands of dollars. Frankly, this has caused great fear in the heart of many busy clinicians, who barely have time to see their patients as it is. Now with ICD-10, there will be an even greater difficulty to provide good care as the temptation to devote most of their time energy to proper coding will be very high, and doctors might chose to spend less time evaluating the things outside the chief complaint.
This new and complex language is causing many seasoned practitioners to retire early. These doctors don’t want to lose their retirement income in fines, so they feel it may be better to cut their losses and get out now rather than to adapt. For those of us who have several decades before retirement, we are committed to learn how to do it right. Electronic Health Records will make the correct code a little easier to input properly. And this is another reason I have started to use them. I want to be able to code correctly and also make my patients, at Northwood Vision, feel as special as they truly are to me.