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Hospitals benefit from conversion


Tribune-Herald staff writer

East Hawaii healthcare providers say that their decision to make an early conversion to an electronic medical record system has saved them both money and trouble, compared to other Hawaii facilities.

As required by the federal Patient Protection and Affordable Care Act, also known as Obamacare, hospitals and physicians must install computer systems that allow for faster and easier access to and maintenance of all medical information records by Jan. 1, 2015. If such systems are not put in place, healthcare providers risk penalties, including reductions in Medicare reimbursements — up to 1 percent the first year, 2 percent in 2016, 3 percent in 2017, 4 percent in 2018, and onwards each year, up to 95 percent, depending on future adjustments.

Dr. Robert D. Irvine, chairman of the East Hawaii Regional Board of Hawaii Health Systems Corp. says that Hilo Medical Center, Ka‘u Hospital and Hale Ho‘ola Hamakua “realized the importance and need for (electronic medical records) more than five years ago,” and the HealthConnect system was selected, installed and went live on May 1, 2010 — half a decade before the deadline.

Getting an early jump on the electronic medical records switchover has ended up benefiting East Hawaii providers by allowing them to earn early adopter incentives provided for by ObamaCare to the tune of almost $3 million.

“We have been extremely fortunate to have a highly motivated, dedicated and hardworking team of nurses, hospital staff and managers, and physicians who have made this possible,” Irvine wrote in a letter to the Tribune-Herald.

HHSC has achieved “stage 1” status in its conversion process, he said. Stage 1 is earned by those facilities which have met by 2012 between 19 and 20 core requirements of the federal government’s standard, according to, an online medical records software directory.

Among the requirements to achieve that stage are constructing an electronic file system for all patients’ health records, building a medical billing system, and inclusion of medical transcription services, which involves converting voice-recorded reports dictated by physicians into text.

Providers will have until the end of 2014 to meet stage 2 requirements, which in most cases expand upon objectives in stage 1, and include new objectives such as allowing patients the ability to view, download and transmit their own health information online.

“The implementation of a complex electronic information system is difficult and time consuming, and we shall be improving our system for years to come,” Irvine wrote. “However, an electronic information system is needed for improved patient care — which is our goal and obligation to East Hawaii.”

The East Hawaii region conversion process has taken about four years so far, costing a total of $20 million, which covers costs for installation, maintenance, hardware and software. It involved the isle’s three public hospitals, as well as 11 outpatient clinics consisting of two cardiology clinics, Hawaii Pacific Oncology Center, Hawaii Island Family Health Center, pediatrics, Hilo Surgical Associates, Hilo Bone & Joint, otolaryngology (ear, nose and throat), urology, neurology, and Ka‘u Rural Health Clinic.

Meanwhile, approximately 65 percent of the physicians across the Big Island have so far implemented their own electronic medical records systems to join the network, said East Hawaii Regional CEO Howard Ainsley in an interview last month.

Getting 100 percent compliance could be difficult he added, and the conversion process to a new system comes with a particular set of pitfalls, as well.

“What is concerning, not only for the Big Island but the whole state, is that there are doctors who will be frustrated with some of these new requirements and they will look to leave medicine. … Some are near retirement, and not comfortable with technology,” he said. “Annually, the state only gets a handful of primary care physicians, but really, we need about 50 a year to stay on pace. We’re already behind the 8-ball in terms of having enough primary care physicians, and these changes are going to make that more difficult.”

The rest of the state’s HHSC facilities are further behind in their conversion process, which has been criticized for running over budget — likely to exceed $100 million, almost double the original estimate of $58 million. Administrators say the overruns are largely due to higher expenses than expected, as well as delays associated with phasing the new system in.

East Hawaii HHSC administrators did not respond Thursday to a request for an interview, including questions concerning any of their own cost overruns and delays in launching their electronic medical records system.

In a 2010 interview, however, HHSC’s East Hawaii Regional Chief Financial Officer Money Atwal said that the system had so far cost about $2 million, not including labor costs for installation and training. The hospital had allotted $3 million of its own money to sustain the record system for its first five years, and expected anywhere from $3 millon to $7 million in grants from state and federal sources to continue development of the system. That amounts to far less than the $20 million total provided in a June 21 press release from HHSC.

HHSC administrators have said in the past that they expected the phase-in process would encounter its fair share of hang-ups, but that eventually, the electronic medical records system will help to pay for itself, by improving efficiency and, more importantly, improving upon the quality of care patients receive.

Email Colin M. Stewart at


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