N.H. Ranks High in  Electronic Medical Records

Concord — At Concord Hospital, a physician treating a patient’s sprained ankle can see whether he has been keeping up with his regular diabetes treatments. The physician can also see how her diabetes patients compare to the patients her colleagues treat, in terms of managing their symptoms.

That kind of insight is more common in New Hampshire than almost anywhere else. The state ranks second in meeting national standards for improving electronic medical records, thanks in part to federal aid.

More than 65 percent of the state’s primary care providers and 85 percent of critical access hospitals are meeting these federal goals. Providers have received more than $76.8 million in federal grant funds in the past two years to help, though that has covered only a fraction of the cost.

Five hospitals from New Hampshire — Concord Hospital, Elliot in Manchester, Exeter Hospital, Littleton Regional Healthcare and New London Hospital — were named to the 2013 “Most Wired” list compiled by Hospitals & Health Networks magazine.

“A lot of the credit should go to the large health care organizations we worked with,” said Jaime Dupuis, practice consultant at the Massachusetts eHealth Collaborative, which helps providers adapt to the standards. “They’ve worked hard to understand and implement the system for their communities.”

The 2009 federal stimulus bill, passed to help the economy during the recession, included money to establish the New Hampshire center and 61 others, and $18 billion in incentives for providers to meet standards of meaningful use of electronic health records.

The standards take effect in three stages, with the second expected to be complete next year. It requires providers to show they are using the electronic records to improve patient outcomes in measurable ways, and engage patients more in their own medical care.

Officials at local hospitals say the incentive grants pay for only a fraction of the investments they’ve made. But since the incentives will end and be replaced with penalties for providers that don’t show meaningful use by 2015, there’s little choice but to make the investments and recoup what they can, officials said.

Those investments, especially at hospitals with larger groups of physician practices, started years before 2009, when the standards were put in place. Concord Hospital began adopting electronic medical records in 1995.

When the hospital built the Family Health Center, one of its founding ideals was the use of electronic medical records, installed with a $600,000 grant from the Anthem Foundation, said Joel Berman, the hospital’s chief medical information officer.

In the past four years, the hospital has received about $5.5 million from the incentive grants, said Scott Sloane, the hospital’s vice president of finance. It’s probably 20 percent of what’s spent each year on information technology, in addition to money spent on personnel to help physicians use it effectively, Sloane said.

In the late 1990s and early 2000s, the hospital bought the practices of many independent physicians in the area — including Berman, who was part of a private practice in Penacook — with the condition that the doctors adopt electronic records, subsidized by the hospital.

In addition to the cost for the hardware and software to run the system, the hospital dealt with increased human resources costs: physicians spent longer putting data in the system than they did when they jotted notes into a paper file. Berman said his practice saw half as many patients in the afternoon for about six weeks, when the staff was learning to work with the electronic records.

Three years ago, the hospital created a new position of education coordinator, teaching new staff to use the system and continuing to update the skills of current staff.

At their best, the electronic records gave physicians at the hospital a window into the total health of their patients and their practices. For example, physicians can create registries of all their patients with a similar condition and create alerts for when patients should visit for regular tests.

In 2003, the hospital began issuing scorecards for how well physicians were using the electronic records. Berman says he saw that one colleague continually had better blood pressure results from his diabetes patients. So he went and asked why, and incorporated what he learned into his own work.

There’s still work to be done. The second stage of standards requires providers to show increased patient engagement in their care through the electronic records.

At least 10 percent of patients have to access their records, which means “we have to make it available and we’re responsible for them actually opening it, so we have to make it more compelling for people to sign up,” Berman said.

Patients can already access their basic medical information through the hospital’s patient portal. They can see their listed allergies, medical conditions, and the medications prescribed to them. They can request prescription refills, request an appointment and some patients in a pilot program can fill out registration paperwork online before a scheduled appointment.

But still, only about 10 percent of patients have signed up to use the portal, Berman said.

Soon, lab test results will be available online after a physician has signed them, which could interest patients enough to draw more of them to sign up.

But all of those records — the patient portal, the information on the score cards, the alerts about missed testing — are only for physician practices under the hospital’s medical group. That system can’t “talk to” the hospital’s in-patient record systems.

Inpatient records are on a patchwork of different systems adopted over the past 20 years. Most can “talk to” each other well, but none can access the outpatient system.

Doctors can send files via email, and the registration department can print those files upon admission, but it’s “a Band-Aid,” Berman said. “It works better than nothing, but it requires a lot of manual labor and when you have human beings involved, mistakes can be made.”

One option would be an “enterprise solution,” one system that coordinates the records for all departments, inpatient and outpatient, pharmacy, lab work, and billing.

LRGHealthcare, which owns Lakes Region General Hospital and Franklin Regional Hospital, will be integrating the clinical records and billing system this fall, said Kevin Irish, the chief information officer.

LRGH has received about $5.5 million since 2009 for the adoption of meaningful use. This year, the organization will spend between $700,000 and $800,000 on maintenance and support of the existing electronic records system, said Paul Onthank, director of finance.

Dartmouth-Hitchcock in Lebanon adopted an institution-wide electronic records system in 2011 at a cost of about $80 million.

Scheduling backlogs, frustration for physicians and patients, and decreased efficiency plagued the first year.

“It was like an airplane changing out its engines in mid-flight,” one doctor told the Valley News in April 2012, one year after adoption. But, he said, “the plane has kept flying. No plane crashed (and the investment) was well worth it.”

Sarah Palermo can be reached at 603-369-3322 or spalermo@cmonitor.com.