Physician super-user Heather Arnold (right) shows general surgery resident L. Marco Hoesel where to find doctors notes on a patient in St. Joseph Mercy Hospital's emergency department soon after the system was launched last fall.

Angela Cesere | AnnArbor.com

When St. Joseph Mercy Health System made an entire switch to a new electronic health records system with parent company Trinity Health last fall, it was a major undertaking.

At the time, the Superior Township-based health system had been using almost a patchwork of different computer applications to store different types of patient information that was difficult to share between departments.

Officials said the upgrade would be well worth it because it would build efficiency and safety into the system's hospitals that had never been seen. Besides, several officials remarked, it was a version of technology all hospitals would have to have some day anyway.

That day is creeping ever closer.

Earlier this summer, the federal government finalized new rules that will give incentives for hospitals and physicians' offices to use electronic health records in a meaningful way.

It's part of a push to get hospitals and physicians' offices across the health sector to invest in electronic health records to better streamline health care delivery and quality. About $27 billion has been set aside in increased Medicare reimbursement rates for eligible medical professionals and hospitals and beginning this year, those incentives will become available to those who prove they are meaningful users of systems that meet the government's definition of a qualifying electronic health records system. After 2015, Medicare penalties will be imposed on those who aren't.

Why does this whole issue matter for patients? 

The electronic health records system allows more options that offer safety and convenience, such as making it easier for patients to check for test results, communicate with their doctor, schedule appointments, pay bills and more easily view their own records, experts say.

And it's central, experts say, to reducing that ever-dreaded process of patients having to repeat their stories with every new health care provider.

For physicians' offices and hospitals electronic records streamline processes they say help increase safety and quality. For example, electronic records reduce the chances for errors made from someone transcribing poor handwriting, can alert pharmacists and physicians to potential medication errors or allergies and can improve efficiency and accuracy of information being sent between departments, such as between a lab, an emergency room or a radiology department and a primary-care physician.

To be clear, electronic health records are not simply records that happen to be stored on a computer instead of one\ paper.

Rather, it's a system of storing a patient’s records in a digital database that can easily be shared across a variety of health-care settings within a secure system-wide network.

Across the nation, health-care providers have a lot of work to do to convert. In a 2009 survey, about 20 percent of doctors reported using the most basic electronic health records and about 6.3 percent reported having a fully functioning EHR system, according to a CDC report. A 2009 study from the Harvard School of Public Health, Massachusetts General Hospital and George Washington University found fewer than 8 percent of U.S. hospitals had basic electronic health records in place.

So where are Ann Arbor's hospitals and physician's offices when it comes to switching to electronic health records?

"Ann Arbor is positioned really well," said Marianne Udow-Phillips, director of the Ann Arbor-based Center for Health Care Research and Transformation. At least the major health groups are, she said.

She pointed both to St. Joseph Mercy Health System, as well as a University of Michigan announcement this summer that it would begin the first phase of a complete overhaul of its health records from a previous electronic system with a $20 million contract with Epic Systems Corp. That phase should be completed in 2012.

"We have much more organization than most practices around the state," Udow-Phillips said. "I think we could be a role model around the country."

Still, she said, it's a major undertaking and it will be years until the technology is truly integrated into the health care system, particularly among smaller practices. In a blog, Udow-Phillips praised the government's attempt to provide technical assistance to practices to help with IT implementation.

"But, we must be realistic about what can be accomplished and how long it will take," she said. "I do believe we will get there. But this is truly a long distance race, not a sprint."

At U-M, the health system was using what it called a sophisticated - if sometimes fragmented - system called CareWeb.

“The health system has multiple systems applications that our clinics use to support patient care and we've done a lot of good work at integrating those systems so data moves from system to system," DeWitt said. "The challenge has been, it's been getting harder and harder to integrate that data."

The health system will begin the process of switching to a new integrated system over the next few months. Officials say they have to analyze all the processes which rely on paper or technology for clinic and administrative applications.

"That is our intent to meet the 2013 deadline," said Joceyln DeWitt, chief information officer for the health system.

On its website, Epic promises its software customers it can help them understand the meaningful use criteria and maximize the benefits of the possible Medicare incentives with its software and processes It's planned that U-M's first portions of the Epic system will be in use for physician billing, registration and scheduling, as well as in its emergency department by fall 2012. Plans are also in the works to have a patient portal that would allow patients to schedule their own appointments, request records, check their bills and communicate with their physician securely.

By the end of 2013, the goal is to implement orders management - or a system that sends physician's orders such as lab tests or X-rays directly to the department where they're needed - in the ambulatory or primary care environment. A system is already in use in the in-patient departments, DeWitt said.

At that point, depending on how well the Epic system is working for the health system, U-M will decide on additional investments, including integrating it into its inpatient unit, she said.

"We're looking to simplify the environment so instead of the hundreds of applications we are using, we are using a single system and not having to do the data integraion on the back end," DeWitt said.

For many physicians' offices, making the switch will be a challenge.

Partners In Internal Medicine, 2200 Green Road in Ann Arbor, has been busily working on checking out new electronic health records systems. It's a priority to get a new system by the deadline.

The physicians group has a bustling practice shared between five physicians and one nurse practitioner in Ann Arbor with a sister office in Canton. The way records have traditionally been taken has been on paper records that are scanned and stored electronically.

It certainly doesn't offer some of the advantages of electronic health records, but the system has worked for the group, said Denise Walter, director of business. Making the switch is going to be a process for their offices and other offices like theirs, she said.

"We've been researching what it is going to take," Walter said. "It's not as simple as buying some software and popping it in." It does involve picking the correct software, ensuring the office has the right hardware to support it, developing new workflows to accommodate the new record keeping system, training staff and physicians on how to use it and reconciling old records with new ones.

It's not a simple or cheap endevor for any office, she said 

"It'll cost us anywhere from $150,000 to get a new EHR. You've got to plan for that. Then, OK, you've got your EHR system, but do have the PCs to support that?"

Walter senses Ann Arbor physicians' offices will probably be more aggressive on investing in the EHR systems in order to reap the potential financial incentives, rather than the penalties.

But it could be tough for rural physician's offices, which have to think about making this investment with maybe one or two physicians, Walter said.

"It is a pretty aggressive timeline," said Jim Lee, vice president for data policy and development at the Michigan Health and Hospital Association. It is a big investment of both money and time to adopt systems that would qualify.

But Michigan, in general, seems to be ahead of the curve in the nation when it comes to electronic medical record adoption. In Michigan, about 23 percent of hospitals have electronic physician ordering systems compared with 17 percent nationwide, Lee said. "I think Michigan hospitals are as prepared as any to meet these challenges," he said.

The MHA is working with the Michigan Center for Effective IT Adoption, which is a federally funded extension center run by Ann Arbor-based Altarum Institute. to help physicians offices adopt the technology.

"Even with that assistance, there will be a lot of physicians who will make that value judgment," Lee said, and choose not to adopt the technology that meets the meaningful use guidelines.

At some larger Ann Arbor area offices like IHA, which is affiliated with St. Joseph Mercy, electronic health records developed by NextGen have been in use for a few years already. "We're well ahead of the curve," said Neal Weinberg, medical director of informatics at IHA.

It's been especially helpful for patients who have to manage chronic health conditions like heart disease or diabetes. "If patient has gone to see cardiologist and makes some changes, next time the patient comes into my office I can see if in real time," Weinberg said.

IHA is among four medical groups that created the Ann Arbor Area Health Information Exchange to securely transmit information among themselves. The exchange is meant to allow offices with different electronic health record software to securely share patient information. A patient's medical history can easily by updated so a physician looks at her or her patient's most up-to-date medical history, Weinberg said.

If a patient at any of the groups within the exchange has to go to St. Joseph Mercy's urgent care or emergency room, the physician on staff would be able to pull up the patient's diagnosis, allergies and medications, potentially avoiding medical errors caused by lack of information, Weinberg said.

A Southeast Michigan Health Information Exchange is still being developed. In February, the exchange won a $2.9 million contract for an Electronic Medical Records initiative from the U.S. Government’s Social Security Administration.

At St. Joseph Mercy Health System, officials say their switchover has put the health system in better position to begin receiving increased Medicare and Medicaid reimbursement rates as soon as possible.

“That’s our goal to meet a large percentage of those meaningful use criteria and being part of Trinity Health, we’ll be finishing as much as we can," said Errol Soskolne, the health system’s chief medial information officer. "We’re prioritizing those changes that are related to patient safety or patient care.”

Since getting its electronic records system, St. Joseph Mercy Health System has reached 100 percent electronic documentation, including all physicians' notes, Soskolne said. About 92 percent of those notes are entered directly by the physician. This is important because it reduces chances for errors dramatically which can be caused from poor physician handwriting.

It also has built-in system to prevent an inadvertent medication mistakes, for example, from prescribing a drug a to which a patient might have an allergy. With Trinity Health having more than 300,000 inpatient admissions among its hospitals per year, it's Adverse Drug Event tracking system sends 200,000 alerts per year. About 5 percent - or 10,000 - of those alerts result in a phone call to a physician questioning the medication ordered and a recommendation to modify drug therapy.

“It’s gone exceptionally well," Soskolne said. “It’s really made a tremendous improvement because data can be accessed both inside and outside the hospital.”

The health system now already meets many of the meaningful use criteria called for by Health and Human Services. For instance, more than 80 percent of the health system’s patients have at least one entry recorded with structured data — one of the requirements.

The health system is reviewing the improvements it can make now that the system is online and folks are getting more used to using it, he said.

“Part of our success was because we committed to 100 percent education and said physicians would not be practicing without being trained,” Soskolne said. “That was really very helpful … Now that we've been live for a few months, we can look at how we can improve. How do we do it better than we've been doing.”