Oregon Public Broadcasting

The Obama administration is nudging the medical industry into making a fundamental shift to a paperless system.

The goal is to greatly reduce health care costs. Providers are dumping their paper files and enlisting computers to keep track of their patients' medical histories.

The administration is offering $19 billion to help health providers make the transition. Many in the Northwest have already taken the leap, but some rural health care providers worry whether theyíll be able to afford the change. Correspondent Doug Nadvornick reports.

Coeur d'Alene surgeon Tim Quinn wants to review the file of one of his patients. He has two options. He can either hunt for the paper file. That's somewhere among the hundreds of folders on the shelves right outside his office. Or he can sit down at his desk and call up the patient's file on his computer.

Tim Quinn: "So this gentleman was having some abdominal pain and he got a C-T scan. So there's the list of the studies that he had. So here's a cross section of his abdomen -- the front and the back."

This is exactly what President Obama has in mind when he talks about electronic medical records. He campaigned on his belief that they'll make the U.S. health care system safer and more efficient.

Dr. Tim Quinn says the digital access saves him a lot of time.

Tim Quinn: "One of the big things is the ability to look at an x-ray and I can be on the phone with the radiologist and they're looking at the image and we're not in the same room like we always used to have to go down, 'Let me go down and talk to the radiologist.' And now I can talk to somebody in Seattle and they could be looking at the same film."

When it comes to electronic records, the Inland Northwest is a national leader. Fifteen years ago, two competing Spokane hospital companies formed a non-profit group to create a cost-effective medical records system that they now share. It's called Inland Northwest Health Systems.

The group's Mark Johnston says the product quickly became very popular.

Mark Johnston: "We started growing, word-of-mouth. We had more of the regional hospitals, you know, they were struggling. IT gets more expensive every year."

Now, Johnston's organization stores medical records for more than 30 hospitals and many doctors' offices. Many are in rural eastern Washington and northern Idaho.

Those providers are way ahead of their peers in other parts of the country who still rely on paper records.

The Obama administration is using both a carrot and a stick to get those facilities into the digital age.

The stick is that the government will eventually reduce its Medicare payments to providers that don't switch.

The carrot is that the government is offering cash to help providers with some of the costs of buying electronic systems. But those grants will get smaller as time passes.

The not-so-subtle message? Get onboard -- now.

But even those who are onboard may have to paddle hard to keep pace with progress.

Boundary Community Hospital in Bonners Ferry serves people in the northernmost part of Idaho. Majestic mountains and the Kootenai River are nearby. Inside CEO Craig Johnson's office, the head of a whitetail deer hangs on the wall.

Seven years ago, Boundary jumped part way into the electronic medical records realm, but not all the way.

Johnson says it was a good investment. Even a limited amount of digital conversion gives patients a double benefit: they can stay home for many procedures, yet they still have access to doctors at bigger hospitals.

Craig Johnson: "It certainly helps the patient as far as cost savings and also the convenience of having studies done here rather than having to travel long distances."

But the government's new electronic medical records push is forcing Boundary to upgrade its electronic system.

Johnson says that will come with a cost: $800,000 up front and another $15,000 a month to maintain.

Craig Johnson: "We're still exploring where we can find the money. We're working with our Congressional delegation to ask them for assistance, to try to direct us where we should write for grant dollars. Because, quite frankly, without that kind of assistance, I'm not sure how this little hospital is going to afford that kind of an outlay."

The financial pressures are even tougher for doctors' offices, especially smaller practices. Johnson says at least two physicians in Bonners Ferry looked into buying electronic medical records systems and passed because of the cost.

Rick McMaster says, eventually, they will have to make the investment. McMaster is the executive director of the North Idaho Health Network, a consortium of hospitals and doctors' offices.

Rick McMaster: "The North Idaho Health Network has been providing some grant money to physicians to encourage them to adopt. We've been asking our health plan partners to provide incentives, payment incentives, to encourage physicians to provide EMR."

The state of Idaho is also involved with digitizing medical information. It has created its own organization, the Idaho Health Data Exchange. It's in the process of creating an electronic information link between two hospitals in Boise and one in Coeur d'Alene.

The transition is not an easy one, but back in Coeur d'Alene, Dr. Tim Quinn says it's worthwhile because records cost money, no matter how they're stored. He looks out his door to that wall of folders.

Tim Quinn: "Those are just the last year of charts. So if you're still keeping paper charts, we have to pay money to store those. And we have a huge warehouse downstairs that we'd love to have the efficiency of having it all computerized."

But he says converting old files from paper to bits would cost $15,000 per doctor in his six-doctor practice. It'll have to wait a little bit.

Online:

Inland Northwest Health Services

North Idaho Health Network