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Only five months after the Massachusetts Legislature’s mandate that health-care providers migrate from paper to electronic patient records, a number of major questions remain about how the initiative is to be funded and implemented.
The electronic records mandate was part of a broad health-care cost-control legislation Gov. Deval Patrick signed into law last August. The act dictates that doctors and health facilities keep electronic patient records and that there be a statewide health information exchange. Such a system would reduce the inefficiencies caused by paper-based systems, lower health-care costs (including paper storage fees), and eliminate potential errors in medical practices, according to advocates.
The deadline date for compliance with the e-records mandate is January 2015. The Legislature voted to fund the implementation with $25 million annually, to be allocated through the newly formed Massachusetts eHealth Institute (MeHI), part of the quasi-public Massachusetts Technology Collaborative (MTC). While the details have yet to be finalized, the MeHI has a broad mandate to assist with the act’s implementation. It includes offering cash, including grants for the information technology systems, technical assistance and vendor certification. However, the funding was reduced to $15 million as part of Patrick’s October budget cuts.
This doesn’t bode well for finishing the job. “It’s certainly not enough money to get the whole state wired,” said David Szabo, a director of the Massachusetts Health Data Consortium, a statewide health data exchange advocacy group. “It’s got to be looked at as incremental.” Szabo is also a member of the life sciences practice at Boston law firm Nutter McClennen & Fish LLP.
The cost to get the estimated 9,000 to 10,000 Massachusetts physicians who aren’t already enabled with electronic records will be in the vicinity of about $400 million, said Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, a nonprofit overseeing several electronic medical record pilot programs in the state. The initial annual $25 million was a “good down payment,” and is expected to be used with other potential sources of cash, such as matching funds from health providers, Tripathi suggested. President Barack Obama has indicated a willingness to fund health-care technology, but as of right now, “that funding is up in the air,” said Trepathi.
Much also depends on the appointment of a nine-member Health Information Technology Council, mandated by the legislation, and chaired by the state’s Secretary of Health and Human Services JudyAnn Bigby. The council would have oversight of the state’s “eHealth Institute,” and must approve its strategic and annual operating plans and all major contracts, according to Mitchell Adams, executive director of the MTC.
Patrick is nearly done appointing the members of the council and plans to announce his selections shortly, said Juan Martinez, a spokesman for the Executive Office of Health and Human Services. In the meantime, members of the MeHI have already met with Bigby to draft the plan and regulations. After the council is appointed, it can review and approve the preliminary guidelines for implementation.
The exact guidelines are also an open question: “The $15 million will be used to advance e-health in the state,” said Martinez. “It has not yet been determined how it will be spent beyond the broad goal of advancing e-health.”
Moreover, the council will be composed of “folks with a lot of different points of view of how the money will be spent and where,” noted Szabo. Some may advocate the $15 million be spent in one or two communities where a critical mass can be created; others may suggest sprinkling it across the commonwealth. “This is where the debate will be,” said Szabo.
Lessons learned: Implementing an e-health system
One administrator at a North Shore hospital network has found creating an electronic health records system a thorny problem.
“We’re definitely not realizing the full benefits yet,” said Richard Mindess, CEO and president of Wellport, a Newburyport-based electronic health records sharing network. After about four years of work, the potential cost and quality improvements are just beginning to show. “We absolutely wish we were further along,” he said.
Wellport now serves two regional physician networks and Anna Jaques Hospital, with about 200 physicians in all. Wellport, which was formally launched last summer, is part of an e-records pilot initiative sponsored by Blue Cross Blue Shield of Massachusetts. In 2004, the insurer awarded a $50 million grant for regional pilot projects overseen by the nonprofit Massachusetts eHealth Collaborative.
The grant funding covered the cost of hardware, software, and some training, said Mindess. Since the project began, Wellport and its affiliated health providers have paid out several hundreds of the thousands of dollars in additional training and other costs. He estimated that a doctor’s cost can run from $30,000 to $50,000 for the hardware and software.
That’s also just the beginning. “It’s up to the user to incorporate the functionality of the system in a way that delivers value.”
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