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One Doctor's Office, Two Opinions On Electronic Medical Records

Lauren Silverman
Both Dr. Calvin T. Simmons (left) and Dr. Edward Kremer have been practicing at Family Medical Associates in Lewisville, TX for decades. While Kremer has embraced electronic medical records, Simmons refuses to let go of paper.

For years the government has been trying to convince doctors to trade in their pads and pens for computers and tablets – and not just because their handwriting is often illegible. The switch plays a fundamental role in achieving the promises of Obamacare -- lower costs and more access. Not all North Texas physicians are taking the bait.

Dr. Calvin Simmons is old school. He doesn’t have time limits on patient visits and relies on manila folders stuffed with paper charts. He’s been practicing this way for almost forty years, and he’s not about to pick up an iPad to take notes during an exam.

“I get patients weekly who say the reason I came to see you is because my neighbor said you would look at me while we were talking,” he says.

Simmons, who works at Family Medical Associates in Lewisville, is among the minority of family doctors in North Texas who haven’t gotten on board with electronic medical records, or EMRs*. EMRs are supposed to make caring for patients easier – simplifying tedious tasks like writing down medical histories, filling out lab requests and managing prescriptions. Simmons says instead of speeding the process up, it distracts him.

“What happens is when you’re doing electronic medical records for the most part, you’re more attentive to the electronic medical records than you are to the patient,” Simmons says.

Dr. Robert Abbate created OneTouchEMR, a startup in Dallas that sells an iPad app to manage electronic medical records, after searching for a software that was easy to use and coming up empty-handed.
Credit Lauren Silverman / KERA News

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A Second Opinion

Texas doctors in small practices are divided. Just look in the office next door to Calvin Simmons.

“I couldn’t function without an electronic record right now,” Dr. Edward Kremer says.

Kremer works with Dr. Simmons, they even cover for each other when one goes out of town. But when it comes time to see a patient, Kremer wheels in a laptop to the exam room instead of carrying a clipboard. He’s an early adopter.

“I started using electronic health record back in 1993, it was a monochrome screen on a portable computer, operating DOS 3.0.”

Back then the system just kept track of basic information and meant less rewriting. The software he uses now, called Practice Fusion, can notify him of allergy alerts and possible drug interactions.

“If I’m at home a patient calls me in the middle of the night I can look of up their electronic health record see what I did to them last,” he says.

It also makes it possible for the patient to access lab results online, rather than having to swing by the office. Dr. Kremer is excited by the potential of cloud-based record keeping and data analysis. His colleague, concerned.

And here’s the thing: each doctor has had patients leave because of their approach to technology – some ditched Simmons, he says, because they wanted him to go digital. Others dropped Kremer because they didn’t like his face glued to the screen.

Dr. Edward Kremer uses his laptop, equipped with a free electronic medical records software called Practice Fusion, to take notes and keep track of all of his patients.
Credit Lauren Silverman / KERA News

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Incentives, And Penalties

The federal government has been trying to coax doctors and hospitals to adopt EMRs and health information technology with financial incentives. But soon there will be penalties instead of rewards. Starting in 2015, physicians not using a certified EMR will have Medicare reimbursements cut by 1%. The deduction rate increases in to 2% in 2016, 3% in 2017, 4% in 2018, and up to 95% depending on future adjustments.

Travis Broome leads policy and oversight of electronic health records at the Centers for Medicaid and Medicare Services in North Texas. He says a key component of Obamacare is switching from paying for services to paying for quality.

“So if you’re going to pay for quality, you need to measure quality,” Broome says. “Measuring quality in the past was very, very difficult without technology and we think electronic health records are the tools we need to do that.”

Broome says 80 percent of hospitals in North Texas have gone digital and cashed in on nearly two hundred million federal incentive dollars.

Soon, neither patients nor doctors will have much of a choice. The future is in electronic health records. It’s how and when we use them that’s up in the air.

*Several definitions exist for electronic medical records (EMRs) and electronic health records (EHRs). You will often hear the two terms used interchangeably, but they refer to slightly different things. The EMR is a software system to replace paper charts. EHRs refer to software that connects physicians and other caregivers and coordinate patient information, such as medications, medical history, immunizations, laboratory data, and radiology reports. 

Lauren Silverman was the Health, Science & Technology reporter/blogger at KERA News. She was also the primary backup host for KERA’s Think and the statewide newsmagazine  Texas Standard. In 2016, Lauren was recognized as Texas Health Journalist of the Year by the Texas Medical Association. She was part of the Peabody Award-winning team that covered Ebola for NPR in 2014. She also hosted "Surviving Ebola," a special that won Best Long Documentary honors from the Public Radio News Directors Inc. (PRNDI). And she's won a number of regional awards, including an honorable mention for Edward R. Murrow award (for her project “The Broken Hip”), as well as the Texas Veterans Commission’s Excellence in Media Awards in the radio category.