More than this writer on the exam table during a recent doctor's visit. Photo credit: Big 3 News (c) 2012

The doctor was hunched over his laptop, a slight wrinkle forming on his forehead. He stared at the screen for a few seconds and then raised an eyebrow with a perplexed look on his face.

“What’s wrong, Doc,” I asked nervously.

Sitting in the examination room at the local physician’s office for my annual checkup, I braced myself for the worst.

“Oh, it’s this new program we’re using,” he replied sheepishly. “We’ve been on it since September but I’m still coming to terms with it. Change is always painful.”

“You mean Obamacare,” I responded in typical interviewer fashion, hoping to stir up a political conversation.

“Well, yes, but this is something that was bound to happen,” the doctor explained. “We’ve been moving to this for a while.”

Electronic records

He was talking about electronic medical records. All of a patient’s health history stored in bytes and readily available to the medical staff — and potentially others — with the click of the mouse.

“It’s making more work for me,” the doctor confessed. “Used to I would just write up an order and give to a nurse to schedule, or send it to the front desk with the patient. Now, I’m doing more of the scheduling detail on the computer.”

The 50-ish doctor sounded bittersweet for days gone by. Was the new system better?

“Well, before this we had our own version of health privacy,” he laughed. “Sometimes we couldn’t find the hard copy records, and when we did they couldn’t read my writing. So, yes, it was encrypted.”

And about the Obamacare thing? I asked him who administered that complex program on his laptop to which he was obviously having trouble adjusting.

“Is that the Health and Human Services,” I pressed, hoping to walk him up to the edge of the cliff with me before he caught on.

“Well, yes,” he said dispassionately. “They give us incentives for practicing within certain standards.”

Improving health care

Health Project Leadership: Senator Tom Daschle, Co-Chair; Senator Bill Frist, Co-Chair; Governor Mike Rounds, State Co-Chair; Governor Ted Strickland, State Co-Chair

This particular medical practice, in fact, received more than $100,000  worth of health IT incentives — out of total funding of about $30 billion authorized by Congress under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 — to encourage its participation in the Medicare EHR (electronic health record) Incentive Programs.

According to Health and Human Services (HHS) Secretary Kathleen Sebelius, the federal government has taken steps to speed up the use of “health IT” in doctors’ offices and hospitals nationwide.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius.  “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

The average EHR incentive payouts for eligible health care professionals can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program, according to HHS.

In a 2011 survey by the Centers for Disease Control, the number of primary care doctors who are using the technology has nearly doubled — from 20% to 39% — between the years of 2008 and 2011.

A new report to be released on Friday from the Bi-Partisan Policy Center about the role of health IT reveals a number of “gaps and barriers” in the system.

Among them:

•  Misaligned Incentives
• Lack of Health Information Exchange
• Limited Level of Consumer Engagement Using Electronic Tools
• Limited Levels of EHR Adoption
• Privacy and Security Concerns
• Multiple Federal Priorities Require Focus and Attention

“Chiefly, protections for health data enacted under HIPAA apply only to certain entities in the health care system (such as most health care providers, health insurers and entities that provide clearinghouse functions with health data),” the 48-page health IT report noted.

“Commercial entities that market health tools directly to the public (such as platforms for personal health records and health-related applications for the Internet and smart phones) are not covered by HIPAA with respect to such tools.”

Looking out for the patient

“So what happens if you disagree with the ‘standards’ set by the federal government,” I shot back. “What happens then?”

“Well, we have the choice to opt out, but we don’t get the incentives,” he said.

Now it was time for the slam dunk. I drew in a huge breath and crossed the line that should never be crossed by a patient with his doctor, especially during a physical exam when he literally has the upper hand.

“Ok, Doc, this is a political question, but Mitt Romney says he will repeal Obamacare if he is elected President. What happens then to your program and all the money that’s already been invested in it?”

He paused. Slowly, he pulled off the rubber gloves and pitched them in the trash can with a slam dunk of his own.

“This won’t go away,” he said of the digital record-keeping system. “But while the experts argue about the standards, and I may or may not agree with them, I’m just going to sit back and keep trying to do the best I can for the patient.”

With that, it was over — the health care discussion and the physical exam. Good weight, perfect blood pressure, a strong heart rate.

But despite the new technology and sophisticated computer programs, the human factor will always exist. No amount of legislation or reform will change that.

Proof? When they scheduled my physical, they failed to tell me I had to “fast”, or not eat anything, twelve hours before the blood work. So, back for a cholesterol check in the morning.

My first real exposure to Obamacare in the digital age — and what the future holds for Americans’ medical records — was more frustrating than any medical procedure.

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