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March 23, 2008 ... The Fallon Clinic, the Worcester-based medical practice with more than 250 doctors, spent $25 million and several years converting to electronic records.

But if a patient heads to a doctor or hospital unrelated to the Fallon Clinic, there’s no guarantee her electronic records will make the trip, too.

“We’re feeling very good about being able to impact the care we provide our patients,” said Edward A. Nazzaro, chief information officer for the Fallon Clinic. “But being able to integrate that with other care in the community is far more daunting than anything we did ourselves.”

Barriers between computer systems, high costs and resistance from individual doctors are among the challenges that Massachusetts could face if legislators approve a bill with provisions requiring medical providers in the state to turn away from paper and adopt electronic health records by 2015, according to some area doctors and officials.

The bill, sponsored by state Senate President Therese Murray, D-Plymouth, represents an effort to address the spiraling cost of health care as Massachusetts continues to roll out its law mandating that citizens obtain health insurance. Under the section of the bill dealing with electronic records, the state would provide $25 million in grants a year for several years to help fund electronic records projects. Doctors would have to demonstrate competency in using electronic records to be licensed, and an e-health institute would be created to oversee the legislative initiatives.

The proposal mirrors federal efforts, state initiatives and individual projects in medical groups and hospitals across the country to go digital.

“It reduces errors, it improves quality of care,” said state Sen. Richard T. Moore, D-Uxbridge, a co-sponsor of the bill. “If we’re going to provide the best quality of care, we’re going to need an electronic system.”

Electronic health records are computerized patient medical records. The broader field of health information technology includes computerized physician order entry, or CPOE, systems, that allow doctors and others at hospitals to enter orders and prescriptions electronically and e-prescribing, which enables doctors to send prescriptions to pharmacies. Other programs help doctors manage their practices.

Shifting to electronic records can free a doctor’s office of towering stacks of paperwork and leave the doctor toting a portable electronic tablet rather than an armful of folders. Proponents say that as a patient travels between doctors, hospitals and offices, an electronic record could help prevent duplication of tests and prescription of incompatible drugs.

The Rand Corp. estimated in 2005 that if all U.S. hospitals and doctors converted to electronic technologies, they could save $77 billion a year. If all hospitals adopted electronic systems, Rand estimated, it could eliminate 200,000 bad drug reactions a year and save $1 billion.

Yet electronic health systems are still sparsely used. About 23.9 percent of doctors working in offices were using or partly using some kind of electronic medical technologies in 2005, according to a survey conducted by the U.S. Centers for Disease Control and Prevention. A smaller number — just 9.3 percent — were using systems with four key components of electronic records, including e-prescribing.

In Massachusetts, about half of all doctors may be using electronic medical records technologies, but that use is clustered in the large academic medical practices and in the Boston area, said Micky Tripathi, president and chief executive of the Massachusetts eHealth Collaborative, which has been working with $50 million in donated funds to bring widespread use of electronic records technologies to pilot projects in North Adams, Brockton and Newburyport. The expense of buying, installing and maintaining systems, as well as the time that takes and the expertise required to manage the process, are among the factors that have hindered wider adoption, Mr. Tripathi said.

“We have a team of 21 people, and we go out and we manage the vendors, we manage the practices and we get them through it from start to finish,” Mr. Tripathi said. “Right now the market is very immature. Most vendors don’t do it.”

Doctor and hospital groups say they support the move to electronic records but caution that doing so won’t be easy for everyone.

The Massachusetts Hospital Association estimates that about 15 percent to 20 percent of Massachusetts hospitals have gone to electronic records, and more are doing so. Although electronic systems stand to save hospitals money in the long run, the short-term costs can swamp budgets, said Lynn B. Nicholas, MHA president and chief executive. She favors seeking financial support from insurers, government health programs and others who pay for health care and stand to benefit from cost savings.

“There could be a surcharge for a period of time,” Ms. Nicholas said. “There could also be outright contributions to a pool that can be drawn down … That may be a way to help hospitals that can’t do this on their own as easily, because clearly this type of investment should be made.”

Converting a small office to electronic records can cost $20,000 to $35,000 per doctor plus thousands of dollars more in additional annual costs for computer systems maintenance, said Dr. B. Dale Magee, a Shrewsbury obstetrician-gynecologist and president of the Massachusetts Medical Society. Some older doctors may choose to retire rather than convert their record-keeping systems, said Dr. Magee, who converted his office to electronic records six years ago and now finds he cannot move his patient data to a newer, upgraded system. Others will be reluctant to invest unless they feel confident a system will function well, he said.

“The standards are going to be critical,” Dr. Magee said. “I think some perspective, a clear-eyed look at what is available and how it works will do much to inform this process.”

UMass Memorial Health Care has been rolling out an electronic health records system to its staff doctors, continuing this year with primary care physicians followed next year by specialists, and will eventually offer technology to affiliated doctors, according to Dr. William F. Corbett, UMass Memorial vice president for community health practice and executive sponsor of the system’s electronic health records project.

The effort has improved access to information about patients in his own office, when one doctor is on call to respond to other doctors’ patients, he said. In other offices, conversion to electronic records has cleared out space for additional examination rooms. Eliminating the step of pulling and filing charts holds the potential to save money, and billing has become speedier, Dr. Corbett said.

“The return on investment has occurred in more efficient billing, cutting the time from service to a bill has dropped,” he said. “Now it’s done electronically, and it’s hours instead of days.”

Full story available at the Telegram & Gazette.

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