By 2015 everybody in the U.S. will be using electronic health records. That's the goal of President Barack Obama, but there is just one problem: What is going to make doctors in small private practices across the country change their process and convert from paper prescription pads to electronic prescriptions and health records?

It's probably going to take more than a 2% Medicare bonus, Stephen Klasko, MD, CEO of USF Health and dean of University of South Florida College of Medicine (Tampa, Florida) told Medical Device Daily. "Nobody's done a proof-of-concept that you can turn around a city let alone the entire USA," he said.

That is the genesis of a new public/private partnership called PaperFree Tampa Bay that launched on March 16. PaperFree Tampa Bay will deploy more than 100 electronic healthcare ambassadors with the goal to convert 100% of physicians in the Tampa Bay area from paper prescriptions, known to be the cause of costly medical errors, to electronic prescribing. The effort is a first step toward the implementation of connected electronic health records (EHRs) to improve patient safety and reduce costs, and intends to leverage funding from the American Recovery and Reinvestment Act.

"We are taking President Obama's vision of an interoperable electronic healthcare system that provides higher-quality healthcare more cost-effectively and making it a reality today in Tampa Bay," Klasko said. "It's not about the hardware or the software it's about changing the DNA of healthcare. We're talking about transforming the healthcare system one doctor's office at a time."

Klasko said the initiative has broad legislative support and he believes it is well positioned to receive federal funding from a portion of the $2 billion in discretionary funds available to the Secretary of Health and Human Services under the Recovery Act. At a recent press conference launching the initiative, U.S. Rep. Kathy Castor (D-Tampa) voiced her support for the funding.

"The intent of the Recovery Act is jobs, jobs, jobs," Castor said. "The Recovery Act calls for the creation of short-term jobs in the community while providing long-term economic stability. If funded, this University of South Florida electronic prescriptions project will create more than a hundred jobs for people who will work alongside physicians in the 10-county area. That will help in the long term as well, especially by improving our healthcare system."

A number of stakeholders, including USF Health and EHR provider Allscripts (Chicago), will fund the initial phase, which will target Hillsborough County's 3,200 physicians. Once the recovery dollars become available, it is anticipated that the program will be expanded to the entire 10-county Tampa Bay region, including the counties of DeSoto, Hardee, Hernando, Highlands, Manatee, Pasco, Pinellas, Polk and Sarasota, which will allow additional hiring to occur.

PaperFree Tampa Bay anticipates that the program will create 132 new jobs: 111 trainers and 21 support staff.

"One of the conclusions we've had is that with physicians it's not just about the software, it's about making it work; it's about their process," Glen Tullman, CEO of Allscripts, told MDD. "The ambassadors' job will be to hand-hold the physician to make this change process easier."

He noted that almost every other industry in the U.S. has already used computers and technology to improve quality and reduce cost, and that is essentially what EHRs and e-prescribing will do for the healthcare industry.

"Everyone has concluded that our healthcare system is fundamentally broken and we've got some work to do on the quality side as well as on the cost side," Tullman said.

The idea of PaperFree Tampa Bay is that it will be a prototype for a number of other communities who are watching the initiative very closely, he said. Specifically, Tullman mentioned that discussions are underway with communities in Connecticut, Pennsylvania and Iowa that are planning to follow PaperFree Tampa Bay's lead. He said, "All across the country communities are looking at this and saying 'why not here, why not us?'"

Federal law empowers the Centers for Medicare & Medicaid Services to pay doctors between $44,000 and $64,000 over five years, beginning in 2011, for deploying and using a certified EHR. In addition, roughly $3,500 in annual financial incentives will be given to doctors who e-prescribe now and will impose penalties on those who do not by 2012.

E-prescribing is a key component of EHR technology, and stand-alone e-prescribing solutions are widely viewed as the quickest and easiest means for physicians to transition from paper medical records to fully electronic records, according to PaperFree Tampa Bay.

"It's a relatively easy first step for physicians and a logical place to start because of the huge cost in dollars and human lives of our current system of handwritten prescriptions that are hand-delivered to the pharmacy," Klasko said.

According to the initiative, less than 10% of physicians in the U.S. currently write prescriptions electronically. PaperFree Tampa Bay will aim to get physicians on board by providing Allscripts web-based ePrescribe software free of charge and offering personalized outreach and one-on-one training to help doctors make the transition. The training curriculum will draw on research conducted at USF Health on how physicians respond to change.

Allscripts ePrescribe requires no download, no new hardware, and minimal training, according to the company. The product can quickly generate secure electronic prescriptions and deliver them to the patient's pharmacy of choice.

"The time to transform healthcare is now we can't afford to wait," Klasko said. "No doctor should feel comfortable that they are practicing the highest quality medicine in Tampa Bay if they are still hand-writing prescriptions."

PaperFree Tampa Bay's vision for the region-wide program is that by the end of the effort, 100% of Bay-area physicians will be registered and trained on ePrescribe, 60% of eligible prescriptions will be written electronically, and 100% of physicians will be introduced to EHR technology.

"We hope the combination of our offering, onsite training, and the new Medicare incentives will eliminate the obstacles and help Tampa Bay physicians embrace electronic prescriptions," Tullman said. "This initiative will transform the entire region into one in which all prescriptions can be wirelessly transmitted to the pharmacy, delivering a simple yet comprehensive solution to a key public safety issue, and providing an on-ramp to a complete Electronic Health Record."

According to an Institute of Medicine (Washington) study, 1.5 million Americans are injured each year and 7,000 die from preventable medication errors. According to USF and Allscripts, benefits of e-prescribing include eliminating errors due to illegible handwriting, creating electronic records to ensure prescription information is not lost, checking for allergies and drug interactions, and reducing costs by improving efficiency and identifying less-expensive drug options.

"I believe strongly that two years from now, no doctor in our community will feel like they are providing safe care unless they are e-prescribing," Klasko told reporters during the press conference. "And right now, at USF, we'll be graduating medical students who have never seen a paper prescription pad."

This new partnership builds on the foundation laid by the National ePrescribing Patient Safety Initiative (NEPSI), a broad-based national coalition led by Dell Computers (Round Rock, Texas) and Allscripts. NEPSI is comprised of healthcare, technology and provider companies dedicated to positively impacting the national prescribing process through electronic prescribing delivery. USF Health is a regional supporter of NEPSI.

"We will look back, two, three years from now and say that the action that President Obama has taken in terms of the stimulus act that promoted rapid adoption of electronic health records and electronic prescribing was in fact the tipping point that changed healthcare and helped us change the healthcare system," Tullman told MDD.

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