electronic health records, page 1

As Medical Charts Go Electronic, Rural Doctor Sees Healthy Change

Published: April 10, 2009
In Washington, the Obama administration is promising to spend billions to make health care more efficient, but Jennifer Brull, a family doctor in rural Kansas, is already a step or two ahead.

Fabrizio Costantini for The New York Times
Dr. Jennifer Brull with colleagues Lynn Fisher, right, and Dan Sanchez, foreground, checking his tablet PC.

Fabrizio Costantini for The New York Times
Dr. Michael Ferris had a different experience with electronic records: his $38,000 system kept crashing.
A year ago, she switched her 3,000 patients from paper charts to electronic health records, a core feature of most plans for healing the nation’s ailing health system. Now, working with computers and printouts, her staff of part-time nurses and shared front-office workers has more time to help her meet the needs of patients.

“I’ll never go back to the old system,” said Dr. Brull, 37, who runs a solo practice in Plainville, Kan. “I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.”

Patients are appreciative, too. Kagay Wheatley brings her 97-year-old neighbor, Charlotte Hayes, to Dr. Brull for blood tests every few weeks. “We do not have to sit and wait while the nurses search for the records,” said Ms. Wheatley, a retired school board aide who is also a patient of Dr. Brull’s. “They find the information right there on the computer, and when we leave, we get a printout of what we did and what she said.”

About 42 percent of active family doctors have installed some type of electronic health records, according to surveys and estimates by the American Academy of Family Physicians, a professional and advocacy group. One in four said they did not plan to purchase an electronic system, and many said they could not afford the $30,000 to $50,000 in start-up costs. The academy has 94,600 members, including about 60,000 in active practice.

Medical centers like the new 24-bed critical-access hospital in Plainville, connected by a walkway to Dr. Brull’s office, are also rapidly adopting electronic records.

“The use of electronic health records and being able to transmit X-rays allows us to be in contact with the whole world,” said Chuck Comeau, a hospital board member who is chief executive of Dessin Fournir, a national furniture design company that moved its head office to Plainville from Los Angeles.

Even so, 8 in 10 of all American doctors still labor in a world of paper. And some doctors said they encountered upsetting setbacks when they tried to switch to electronic records.

Michael Ferris, a 33-year-old emergency medicine physician in Parsons, Kan., said he had to give up his solo practice after he had invested $38,000 in software for systems that kept crashing and thwarting his attempts to send out electronic bills. “I was spending as much time trying to fix the computer and the billing as actually seeing patients,” he said, “and neither process was generating any revenue for me.”

Now, as director of the emergency room at the Labette County hospital in Parsons, Dr. Ferris said, “I get paid by the hour and don’t have to worry if the software is down.” But he said he expected that some day he would have to help the hospital make the transition to electronic records. “I know it is coming.”

Information technology for health care is a $20 billion section of the $787 billion economic stimulus package President Obama signed last month. But only part of the new I.T. financing will help individual doctors who convert to electronic health records, said Dr. Steven Waldren, director of the center for health information technology at the academy of family physicians. Those in rural and underserved areas should benefit the most.

“For the vast majority of physicians, there is not going to be upfront money to purchase electronic record systems,” Dr. Waldren said.

Dr. Brull, who grew up in Grinnell, Kan., a town with 250 residents, has been an advocate of electronic records since she was in medical school at the University of Kansas in the 1990s. Seven years ago she moved to Plainville, where she rents space in a community-owned medical office building and shares a receptionist and bookkeeping staff with two other family physicians, Dan Sanchez, 45, and Lynn Fisher, 34.

They have 8,000 patients in all, including some from neighboring counties. The three doctors together cover a lot of ground: delivering babies, performing colon cancer checkups and staffing the emergency room at the hospital. They refer patients who need intensive care or a specialist to the Hays Medical Center, 23 miles away. Trauma patients are flown to Wichita, a one-hour helicopter ride. Specialists, including a cardiologist, come to Plainville to provide follow-up care.

The three are the only doctors in Plainville, a city of 2,500 in Rooks County, a wheat farming and oil-producing area midway between Kansas City and Denver. “We are it,” Dr. Brull said.