Health care facilities in the region are joining a nationwide effort to make medical records available electronically to cut down on costs and waste and allow medical providers in different areas access to patients’ medical records.

Many facilities in Minnesota, North Dakota and South Dakota already access medical records electronically or are in the process of developing, testing and implementing Electronic Medical Record (EMR) or Personal Health Record (PHR) systems.

Making health records available online in the electronic form of PHRs, which include medical histories updated by patients, could result in industry savings of $13 billion to $21 billion a year in the U.S., according to a November article in the Journal of American Health Information Management Association.

Rural health care facilities have lagged behind in converting to electronic records systems.

Lynette Dickson, program director for the State Office of Rural Health in North Dakota, said federal stimulus package funds aimed at supporting the advancement of health information technology will put pressure on some rural health care facilities that have not developed EMR plans.

A recent survey conducted by the Center for Rural Health to assess the adoption status of EMR systems in North Dakota found that larger hospitals use EMRs at a much higher rate than rural facilities.

“There’s an obvious rural/urban divide amongst health care facilities with regard to IT staff support and financial resources as well as much-needed planning activities,” Dickson said. “Although one third of rural hospitals indicated they had some level of EMR adoption, we know most don’t have a fully-functional system. We’re cautiously optimistic that stimulus package money may provide some grant opportunities to facilitate adoption of EMRs.”

Dickson said that most stimulus package dollars for Health Information Technology (HIT) will fund Medicare and Medicaid incentives to encourage the adoption of a certified EMR system capable of exchanging information from site to site. The incentive programs will be phased out over time, replaced with financial penalties for providers not using EMRs. Stimulus funds will also be available to states to set up loan and grant programs to cover planning and implementation costs of Health Information Exchange (HIE) systems. Dickson said this puts the onus on states to support the effort as matching funding from the state will be required to access federal dollars.

Dickson said the challenge of covering up-front costs to invest in an EMR system remains a challenge for rural providers. North Dakota’s Health Information Technology Steering Committee has been in place for more than two years, but is made up entirely of volunteers and its power is limited. Dickson said North Dakota doesn’t have a state office

Responsible for providing oversight for HIT or HIE. Caryn Hewitt, executive partner for health information management at MeritCare Health System, said MeritCare began establishing EMRs 10 years ago because of the size of its market area. MeritCare — North Dakota’s largest private employer — encompasses 20 locations in the Fargo-Moorhead area, 19 regional Minnesota clinics, eight regional North Dakota clinics and a regional hospital in Thief River Falls, MN.

“We have about 1.5 million patient records online,” Hewitt said. “No matter where a patient or provider is, if they have access to the MeritCare system, they can access those records.”

Hewitt said the benefits of MeritCare’s electronic records also reach rural hospitals that haven’t yet implemented an EMR system because MeritCare providers work in the hospitals and MeritCare clinics are often located near hospitals.

The cost of licenses, software installation and upgrades, equipment and training have prohibited some health care providers from making electronic records available. Privacy and security issues as well as individual state regulations also come into play. Many of these issues will be addressed through government HIT initiatives.

Sioux Falls-based Avera Health and Sanford Health have spent years developing and testing electronic medical records systems and utilize EMR and PHR systems in portions of their health care systems. Avera Health, which encompasses five regional centers and more than 230 locations in South Dakota, North Dakota, Minnesota, Iowa and Nebraska, plans to use EMRs system-wide by late 2010. All but one of Avera’s hospitals currently utilize EMRs and a recently-acquired hospital in Marshall, MN, is scheduled to implement EMRs in November.

Avera Health began offering online appointments at its McGreevy Clinic Avera locations three years ago as a step towards adding a PHR system. Current economic conditions will affect how quickly PHR software is implemented.

Sanford Health, which serves nearly 100 communities in parts of South Dakota, Minnesota, Iowa and Nebraska, recently completed a three-month PHR pilot. My Sanford Chart will allow patients to review clinic visits, request prescription renewals and schedule appointments online. Dr. Dan Heinemann, chief medical officer of the health services division at Sanford Health, said the pilot program allowed Sanford to fine tune the system before making it available to patients.

“PHR gives physicians another avenue of communication,” Dr. Heinemann said. “Patients can view their chart at night, weekends and schedule appointments when it’s most convenient for them. This paves the way for physicians to look at e-visits and e-health.”

Sanford officials said its PHR system utilizes a highly encrypted and secure process and is more time and cost effective.

“As our system develops, patients will be able to complete their own patient history before they come to the office and can be seen immediately because the physician already knows why they’re there,” Dr. Heineman said.

South Dakota’s eHealth Collaborative, initiated last spring, will result in a long-range plan to help facilitate information sharing between the state’s health care organizations and systems.

“Business owners are very interested in managing health care costs,” said Jim Veline, Avera Health’s chief medical information officer. “Electronic systems provide many cost-saving benefits.”

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