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Florida's electronic medical records

A $35-billion federal investment in getting health care providers to replace paper charts with electronic health records was a windfall for software vendors. Whether it has helped improve health care is another question.

In 2009, as part of an economic stimulus package, President Obama signed the Health Information Technology for Economics and Clinical Health (HITECH) Act. The law provided financial incentives to doctors and hospitals that adopted electronic medical records and achieved “meaningful use” of the electronic format. Obama said the $35-billion taxpayer-funded investment would “reduce errors, bring down costs, ensure privacy and save lives.” Providers who didn’t move to replace paper charts with electronic records, meanwhile, would be penalized with reduced Medicare reimbursements.

The subsidy — qualifying doctors could receive up to $63,750 over six years under Medicaid or $43,720 over five years under Medicare — unleashed an entrepreneurial surge, with hundreds of software vendors, including several in Florida, rushing to develop electronic health records software and market it to physicians and hospitals.

In some ways, the law worked as intended.

In Florida, roughly a third of physicians were using electronic health records (EHRs) in 2008, and fewer than 20% of hospitals had even a basic EHR system in place. By 2017, eight out of 10 Florida doctors and 97% of hospitals had implemented a federally certified EHR. Adoption rates are similar across the nation.

The electronic systems helped eliminate some problems — confusion resulting from illegible handwriting, for example — and streamlined the way doctors order tests and prescribe medications. The EHRs also have made billing easier for many doctors and hospitals, and vast amounts of data accessible at the click of a button provide an opportunity to improve clinical decision-making — at least in theory.

But the digital shift has come with unintended consequences. In some cases, it has meant more work for health care providers. Often, EHR systems from different software companies can’t communicate with one another, and buggy software can contribute to medical errors. Several leading software vendors, meanwhile, have paid multimillion-dollar settlements to resolve government allegations of kickbacks, false claims, cheating on federal certification tests and other charges.

“The intent (of the HITECH Act) was very good, but it’s sort of important to realize it has not resulted in this miraculous change in the practice of health care,” says Bob Hoyt, a physician who served as director of the University of West Florida’s medical informatics program from 2004 through 2017. “The problem is that in spite of spending $35 billion, they certainly have not saved (patients) any money, and it’s not clear they’ve saved any lives.”

Following is a look at the key pain points associated with EHRs and how Florida doctors, hospitals and vendors are tackling some of the challenges.

Read more in Florida Trend's April issue.
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