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Many docs balk at e-records

Tradition, cost cited as reasons not to give up on paper

Washington orthopedic surgeon Vincent Desiderio doesn’t mind flipping through folders. His office has seven filing cabinets full of patient charts, some as thick as two inches.

Despite feeling the federal government’s push to move to electronic medical records, Desiderio, who has been in practice for more than 30 years, likes his paper file system and may retire before he’s convinced to switch.

“I think that electronic medical records are the future – there is no doubt the industry is going to go paperless,” he said. “But I don’t want to go through an extensive revamping of how I see patients.”

Desiderio isn’t the only one who would rather stick with a traditional system than take part in medicine’s digital revolution, which would take him months to transition into – and cost plenty.

In August, the Centers for Medicare and Medicaid Services released the final battery of rules – known as Stage 2 – for how doctors should use electronic health records.

To nudge doctors to make the switch to electronic records, which are said to be more efficient at tracking patient care, the federal government is offering financial incentives, and in 2015, it will penalize physicians who lag behind.

To date, around 55 percent of doctors have complied, about on par with the government’s projections. But many well-established physicians are not wild about making the transition.

Jonathan Plotsky, a Rockville, Md., internist who has been in practice for 20 years, is sticking with paper for now. He said that over the past year he has met with countless EHR vendors; they would install the required software for about $30,000 and charge $2,000 a month in subscription fees. But Plotsky feels that the software doesn’t do enough to guard against gaps in treatment. For example, an EHR wouldn’t automatically register that a patient of his received a flu shot at another medical office, he said.

Technology has changed most industries, but many doctors’ offices still run as they have for decades, with receptionists requesting faxed paperwork and physicians leafing through thick folders with years of scrawled medical history stapled inside.

Medical students may now be accessing textbooks on their iPads, but much of “health care has stubbornly held onto its cabinet and hanging files,” as Health and Human Services Secretary Kathleen Sebelius remarked at a conference last year.

Policymakers sought to breach that technological gap with a 2009 law that aims to increase EHR adoption to 90 percent for physicians by 2019.

Since last year, the government has been offering up to $44,000 over the course of five years in extra Medicare reimbursements – or up to $63,750 through Medicaid – to physicians who had become “meaningful users” of certified EHR technology.

The Stage 2 rules dictate that doctors seeking this money must be using a system that provides digital summaries of each office visit and allows patients to view their health information online.

Starting in 2015, physicians who don’t use the digital records will see their Medicare payments cut by 1 percent, a penalty that will escalate to 3 percent by 2017.

But many doctors say these carrots and sticks aren’t enough, given the hassle of the switch.