O’Malley expected to sign bill that would aid in creating national health information network

Maryland is poised to jump ahead of the rest of the nation in health information technology on Tuesday when Gov. Martin O’Malley signs a bill intended to coax doctors into using electronic medical records.

The computerized files are seen as the foundation of a national health information network that proponents say will improve care, advance medical knowledge and save the country tens of billions of dollars annually. But with the startup costs to individual doctors in the tens of thousands of dollars, many smaller practices have been slow to move from clipboard to computer screen.

With today’s bill signing, Maryland will become the first state requiring private insurance companies to offer doctors financial incentives to adopt the technology, state officials say. Doctors who do not bring an electronic medical records system on line by 2015 could face penalties.

“This is where government and private health care providers can come together to really improve not only the quality of care but also, hopefully, create some costs savings as well,” O’Malley said. “Health IT is the future of health care in our country, and we want Maryland to lead the way.”

The bill also requires the state to develop a health information exchange, a computer network that would link all of Maryland’s physicians, hospitals, medical laboratories and pharmacies. It could be linked in turn with those of other states to create the national network envisioned by President George W. Bush and affirmed by President Barack Obama. O’Malley calls it “creating one common gauge of railroad track.”

Obama, who has promised to spend $50 billion on the effort over the next five years, set aside $17.2 billion in the economic stimulus package to encourage the adoption of electronic medical records - sophisticated computer programs that record a patient’s history, incorporate the latest medical research and propose appropriate treatments.

Privacy advocates warn that the features that make the computerized patient files attractive to health care providers - the wealth of personal information, and the ease with which it may be accessed and shared - also make them ripe for potential exploitation by employers, insurers and others. State and federal officials acknowledge such concerns and say safeguards will be incorporated into the new systems.

The stimulus money went to Medicare and Medicaid, which are to give it to doctors who adopt electronic medical records. But because Medicare and Medicaid account for less than half of payments to many providers, state Health Secretary John Colmers said, private insurers are now being enlisted to add incentive, beginning in 2011.

The bill allows insurers to choose among several forms of inducement - increased reimbursements, lump-sum payments or in-kind services - so long as it has a monetary value.

“The goal here in Maryland was to assure that all of the payers pull their oars in the same direction,” Colmers said. “There is a great promise in electronic health records, but the greatest promise comes when it’s done in a coordinated fashion, across all of the payers.”

Bush’s goal was to get all of the nation’s physicians using electronic medical records by 2014. The next year, insurers in Maryland may begin to reimburse holdouts at lower rates, according to the state measure.

Jeff Valentine, a spokesman for CareFirst Blue Cross Blue Shield, congratulated O’Malley and the state legislature on what he called “an important first step to maximize federal stimulus funding.”

The largest health insurer in the mid-Atlantic, CareFirst, already offers increased reimbursements to doctors who use electronic medical records, which Valentine said would lead to “improved patient outcomes and safety, lower costs associated with care delivery and an overall improved patient experience.”

The state began work on a health information exchange last summer, when the Maryland Health Care Commission asked two very different physicians groups to develop pilot programs and advise the state on how a statewide exchange should function.

The Chesapeake Regional Information System for our Patients, or CRISP, included several large Baltimore medical institutions, Johns Hopkins Medicine, MedStar Health and Erickson Retirement Communities among them. The Montgomery County Health Information Exchange Collaborative brought together community hospitals, the county health department and clinics that serve the poor and the uninsured.

“It’s a population that is, in many ways, invisible and not so well-connected to health care,” said Montgomery County group member Dr. Tom Lewis, who helped launch an electronic medical record initiative in a group of county clinics in 2003. “They may get care in emergency rooms and a web of free clinics, but we want to bring individual patients’ data together in one place.”

Because low-income patients tend to receive fragmented care, Lewis said, they have the most to gain from the sharing of electronic medical records among healthcare providers. For example, without such sharing between community clinics and hospitals, he said, emergency room doctors who provide much of the primary care for these patients may be unaware of their health histories, leaving the patients at risk of receiving unnecessary or unsafe procedures.

The group’s pilot project created a health information exchange that links 10 community clinics with Montgomery County General Hospital’s emergency room. So when a patient arrives at the ER, doctors can access an electronic synopsis of his or her medications, allergies, lab results and medical visits.

The emergency room can send discharge information directly to a patient’s clinic, which might not otherwise know about the visit. The group hopes the effort will cut down on unnecessary emergency room visits, by better connecting patients with clinics.

The pilot program is set to roll out in a few months, Lewis said. He said his group doesn’t plan to bid on a statewide information exchange, but has been eager to share its findings with the Maryland Health Care Commission.

Applications from groups hoping to design a statewide health information exchange are due to the commission by June 12. The commission is to award a contract in August. Startup costs are to be funded in part by stimulus money and in part by the rates that hospitals may charge.

The statewide network is likely to be phased in over time, said Colmers, the state health secretary, with the first elements coming on line as early as this fall.

“I expect fairly rapid adoption,” he said. “And with the incentives in the stimulus package and in this bill beginning to go into effect in ‘11, it will be important for it to be certainly ramped up and ready to operate by then.”

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