A doctor works at a temporary clinic.
Tampa Bay is staging a revolution. Residents, mark your calendars — it begins on Monday, in your doctor's office.
The city is about to announce that on Monday its mayor, representatives in Congress and health-care professionals will launch a new effort to make health records completely paper-free. That means digitizing every prescription and patient history written not only in the 10-county area surrounding Tampa and St. Petersberg, Fla., but also, eventually, in the rest of the country. Over the next two years, Tampa's leaders plan to train every one of the 8,000 physicians in the area in electronic prescribing, with the goal of having at least 60% of all eligible prescriptions by Tampa Bay doctors written on a computer instead of a prescription pad.
That's just the start. The Paperfree Tampa initiative aims to change completely the way doctors prescribe and practice medicine, by digitizing the entire medical record-keeping process, from patient charts to lab reports and test results. Already, other U.S. cities, and even some states, have joined the movement at the urging of its highest-profile supporter, President Obama, who campaigned on the promise to make every government health care agency entirely electronic by 2015. In Hartford, Conn., the recently launched Health Info Exchange network electronically connects the nine major hospitals in the area to pharmacies and doctors' offices. Doctors and health officials in Pittsburgh are also on board to digitize the city's medical practices. And a group of hospitals in Iowa hopes to use a 3,600-mile fiber-optic data network, purchased by the Iowa Health System, to become the first state to go totally paper-free in health care.
But despite all the high-level enthusiasm for medical record-keeping, it is the doctors themselves who have been slow to espouse the system. Major pharmacy chains now accept electronic prescriptions and use software to detect drug-drug interactions, but only about 10% to 15% of physicians nationwide have swapped their prescription pads for computers. "How can you make the nation's health system electronic when you haven't even had an area or a city to show that they can do it?" says Stephen Klasko, dean of the college of medicine at the University of South Florida and an architect of Tampa's effort. "We will become proof of concept that it can be done."
Proponents of digital medical records say the issue goes beyond saving paper and money. Studies have shown that computerized prescriptions can save lives as well; the National Institute of Medicine recently reported that prescription errors cause at least 7,000 deaths each year, and electronic prescriptions can reduce those mistakes by catching misdosing and drug-drug interactions. E-prescribing can also cut costs; last year, a study from Brigham and Women's Hospital showed that prescribing software that can identify both generic drug options and medications covered by a patient's insurer, has the potential to save up to $845,000 for every 100,000 patients each year.
Klasko is convinced the Tampa experiment will work. With $1.5 million in private and public donations and a boost from Allscripts, one of the leading software vendors of electronic prescriptions, which is providing its programs for free, Tampa's plan includes hiring and maintaining a new workforce dedicated to training and monitoring the digitized health system. Ultimately, Klasko anticipates that 110 or so of these "electronic health ambassadors" will be needed to cover the Tampa Bay area; 10 to 20 will be deployed on Monday. Their job? To visit every doctor's office, no matter how big or small, and teach its entire office staff how to keep electronic health records on the computer. "We've found that although electronic prescribing is now available, doctors are just not using it because they still have so many unanswered questions — how much does it cost, how safe is it, how is privacy protected, how much work will it entail, and what do it get from it?" says Klasko. "We're going to answer those questions."
In fact, doctors anywhere in the U.S. have had access to the same prescription-writing software from Allscripts for free off the Web since 2007. The cost is underwritten by many of the technology and health industry's biggest names — Cisco, Dell, Google, Microsoft, Aetna and Wellpoint. (The upside for Allscripts is potential future sales of its full medical record-keeping software to early adopters of the e-prescribing program.) But even freebies aren't enough to get doctors to change their paper-scribbling ways. Many still find old-fashioned pen and pad to be more efficient. A recent study found that doctors dismiss 90% of the alerts that automatically pop up on e-prescribing programs as not relevant. They say they find these alerts tedious: for a veteran cancer doctor prescribing anti-nausea medications to patients on chemo, for example, an e-reminder about the drugs' dosing regimen isn't so much helpful as it is irksome and unnecessary.
So, to give doctors a better reason to prescribe electronically, in 2003 the government allowed doctors to be paid a bonus of 2% of their Medicare reimbursement, or up to $5,000 a year, beginning in 2009 if they wrote electronic prescriptions. These incentives will start to phase out in 2011, however, and in 2012, the system will introduce de-incentives: any physician not using e-prescriptions will be penalized by 1% of his Medicare reimbursement.
But before then, with the President's backing, the right technology and the monetary carrots to motivate doctors now, Tampa is convinced it will become the first fully wired health-care city. City officials, along with their U.S. Senator Bill Nelson, are holding out for a portion of the stimulus package, in the neighborhood of an additional $18 million, which will guarantee that their program will reach all 8,000 doctors in the Tampa area. "We will literally change the DNA of health care one doctor at a time," says Klasko. Such genetic therapy isn't always easy, but if the country's health system is going to be reformed, getting rid of illegible prescriptions is a good place to start.