MN health providers fall short on digital records

Nurses check computer log
Nurses checked the the computer log at Allina Health-United Hospital, Sept. 20, 2013. While all hospitals and most primary care clinics are complying with new rules, the state Health Department says many dentists, mental health professionals and chiropractors are not.
Amanda Snyder | MPR News 2013

Minnesota officials say thousands of health care providers are violating the state's new rules requiring electronic patient health records — but there isn't much they can do about it.

State regulations that took effect Jan. 1 call on all providers to use sharable electronic health records. But while all hospitals and nearly all primary care clinics are complying, the state Health Department says many dentists, mental health professionals and chiropractors are not.

The department argues the digital rules make health care safer and more efficient. Some providers, however, say converting from conventional paper record keeping is too expensive. Others say they worry about patient privacy.

Some state lawmakers are paying attention. A bill moving through the Minnesota House would let providers with seven or fewer caregivers opt out of electronic record keeping. That would exempt about 80 percent of clinics from the mandate and defeat the purpose of the rule, officials say.

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"There are very strong patient benefits to electronic health records," said Diane Rydrych, director of the Health Department's policy division. "The reason why we have a mandate is because we want to make sure that those benefits are shared with all patients."

The federal government also has a new requirement for electronic health records, and if health care providers fail to comply they will see reduced Medicare payments. But providers who don't depend on a lot of federal money have less of an incentive to comply with the federal mandate.

When doctors and clinics keep electronic records that can be shared with other medical professionals, their patients get better care, Rydrych said. That was the reason lawmakers passed legislation eight years ago calling for the digital records conversion by the start of 2015.

"If I go to see my doctor or any caregiver that I might have, it's important for them to know about things like allergies, other tests that I've had, other conditions that I have so that they can be providing appropriate care for me," Rydrych said.

Some health care professionals worry about the privacy of electronic records. It's a particular concern in practices such as psychotherapy, said St. Paul psychologist Peter Zelles.

Zelles has yet to upgrade to electronic records but said he intends to comply with the law.

Still, he's concerned that putting everything on computers might give too many people access to deeply personal information clients might not want shared. Some women, for instance, might not want to share information about an abortion with other health care providers.

"Patients have talked to me about being treated differently after that experience," Zelles said. "Some patients are treated differently because they are being treated for mental health problems."

State officials say people who don't want their information shared have the legal option of telling their provider not to release it. They say some providers may not understand how electronic record keeping works.

For example, there is no central, online database of people's health information. Instead individual systems are designed to securely share authorized health information among providers.

Digital data is critical to improving care and reducing risk, said Scott Gerdes, chief financial officer of the Zumbro Valley Mental Health Center in Rochester where people get a variety of mental and physical health services.

Patient data at the clinic is collected electronically and patients, not caregivers or government officials, decide what information can be shared, he added.

"We still have to have releases from individuals to pass those records back and forth."

The Health Department isn't planning to seek more power to enforce the new rules. Rydrych, though, concedes that without a penalty for not complying, officials can do little more than try to convince all providers that electronic record keeping is a good thing for their patients.