"The intent is for everything to be on an electronic health record," Burris said. His practice, with 27 physicians and 110 employees, began using electronic medical records, or EMRs, in 2002. Calling it a "gradual process," Burris said his staff started by storing images such as x-rays on an internal database. Most recently, the company converted all its billing records into electronic form. Burris said Premier will begin sending electronic prescriptions by the end of the year. The entire practice should be EMR integrated by 2011.

 

"The biggest advantage is that these records are never lost. We can access them on the road or working from home," commented Burris. He said the switch to electronic records also frees up office space that can be used to treat more patients. EMRs can also be crucial for follow up visits and making decisions about patient care without a lengthy review of paper records.

 

But the biggest push for electronic record keeping is coming from the federal government. EMR's are expected to become the industry standard by 2015 according to guidelines established by President Barack Obama's administration this year. Specifically, the American Recovery and Reinvestment Act of 2009 has set aside approximately $19 billion for physicians to adopt electronic medical record systems under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

 

Starting in 2011, physicians can earn up to $44,000 each in extra stimulus payments over the next four years if they can prove they have a sustainable, functioning system in place.

 

The key to receiving that funding is to prove that the EMRs are being used in a meaningful way. The government is expected to issue specific standards by the end of the year to help define the so-called "meaningful use" standard.

 

Dr. David Blumenthal, National Coordinator for Health Information Technology, said in a statement that "meaningful use" will include specific activities healthcare providers need to be doing to qualify for the incentives

 

"We recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care," Blumenthal said. "Meaningful use will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day."

 

The amount of funding available will drop by 2013 and by 2015, doctors will face a series of escalating cuts in Medicare payments, up to a five percent cut in reimbursements, if they lack a records system.

 

"You have to make the investment up front and hope to get the money back," Burris said.

 

The investment can be over $50,000 per physician according to the latest industry estimates.

 

Experts also say the entire process of choosing a system and a provider, installation and getting "up to speed" on the use of EMRs can take up to two years. That means doctors without EMRs currently are almost out of time if they want to get the bonus payments.

 

"Physicians need to be cautious in thinking they can just plow through this in a few months," said Karen Barrow, special projects manager for Premier. But she said the benefits already outweigh the time and expense. "We look forward to being able to use the system when it's fully integrated."

 

Burris said Premier is on track to meet the 2011 benchmarks. "It's a choice we would have made anyway."

 

One of the most significant aspects of the "meaningful use" standard is the ability for medical practitioners to share electronic records with hospitals and other clinics. But it's also the one that is the most challenging, according to Burris.

 

"Being able to exchange data through a network is a critical part of the process," he said. "But it also means everyone has to be on a compatible network."

 

That uniformity is slow in coming, but hospitals in Tennessee are working on a solution, thanks in part to the urgency created by the HITECH Act.