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Editor’s note: Dr. Richard Maffezzoli is a founding partner of Clinical Associates, Ltd., an 80-physician practice with eight locations in Baltimore County, Md. While he has been a practicing physician for 33 years, more recently he became chief financial officer for this multi specialty practice. In the following interview, he discusses the potential advantages of electronic medical records and the challenges involved in making the switch. This is one in an occasional series of Q & As with RSM McGladrey Advantage editorial board members.

What caused you to consider moving to electronic medical records?

It was an evolutionary thing. For example, all of our primary physicians have been using online prescribing, which a lot of people complained about on the front end. However, they’re now so comfortable with it that we don’t even save paper slips on refills, because all that information is stored online.

More recently, we installed a practice-management system by a company called NextGen Enterprise Practice Management System, one of the packages the federal government has determined would be adequate. We did this with the idea that once we get the accounting portion of the system running smoothly and find a funding partner, we’ll take the next step to digitize our medical records. We figure that process will take anywhere from six months to a year.

What are some of the key benefits you expect?

The main upside is that electronic medical records will help improve patient care by reducing errors and duplication in files. It also will help our doctors be more productive, because they won’t have to do things like flip through paper charts while seeing patients. And, at least in theory, this change should allow us to get rid of most of our traditional medical records, which would cut our storage costs. The first two benefits would be immediate, while the storage benefit might not be fully realized for three to four years.

What are some of the issues you’re facing?

Well,the first one is cost, which is about $500,000 for a practice of our size. So, we’re looking for a hospital to partner with us to help fund the system. Second, once you install such a system, you need to determine how quickly you can implement it. On the front end, it will cost more money, because productivity will drop during the training period. That means we’ll need to manage this gradually, because we cannot sustain any real revenue declines in the current funding environment. And third, if we put a system in now and pay for it, how do we know it will be the system? That’s a major concern the government hasn’t addressed. There is no "Microsoft for medical records," even though that kind of single provider would be really useful [although some trade associations in the health care industry believe competition will drive vendors to develop interfacing products].

How will the doctors access electronic patient information?

Within our office locations, I envision a series of portable tablet computers. Since most of our doctors are already carrying a Palm or other PDA [personal digital assistant] device, they are already comfortable with accessing online information away from the office, so we’ll ensure that our system is compatible with those devices.

How will this change affect privacy and portability of patients’ medical records?

Ultimately,I think the government needs to step in and say to a patient, "Here’s a form you need to sign to designate hospitals and emergency rooms in the area that can have access to your medical records." But even if that happens, it would be an administrative nuisance to manage. Another idea, one I do like, is to offer patients the service of buying their electronic records on something like a portable key chain drive, which would be useful in an emergency situation and could be password-protected. That way, they wouldn’t need to deal with the forms, and they would have direct control over how their files are maintained and shared.

What about billing? Will this new form of record-keeping improve the process?

In theory, the answer is yes. If a doctor fills out an online patient-history form and checks off on the diagnosis, a series of procedure codes will appear. Those codes help a doctor fully document procedures to qualify for the appropriate reimbursement. It’s harder to do these steps systematically when using written records, simply because of the time involved in dealing with the forms. The electronic medical records system will actually provide doctors with prompts,helping them quickly define the specifics of a procedure and the corresponding rates. In the long run, this process should allow them to fill in information more quickly, which should lead to higher productivity and more revenue.

In your estimation, how long will it be before the full benefits of this change are realized?

Most likely three to four years, which is why I think there aren’t many major medical groups, operating solely on private revenue, that have taken this step.

Is that another reason you’re seeking a hospital partner to share the implementation costs?

We’re looking at that kind of alliance because costs keep going up and reimbursements are flat to down. If we create an alliance, the upsides to the hospital partner are convenience and an increased number of referrals. In our area, for example, there are plenty of hospitals — including two within three miles of our main office. If we can offer medical records that integrate seamlessly with a partner hospital, and if the level of care is as good as or better with the partner than with another hospital provider, why wouldn’t we seek out this kind of alliance? It would be a win for our patients, the hospital partner and us.

If you were advising another medical practice on this issue, what would you say?

In the absence of one uniform electronic medical records system, which I think would save billions of dollars and be far more useful to patients and doctors, I would advise practice groups and hospitals to limit their options to the 10 or so electronic technology providers the government believes are worthy of consideration. Then, I would suggest that they implement it gradually, and expect to have some revenue and productivity declines on the front end. Finally, I would suggest they look for a cost-sharing partner, which would make deciding to move ahead much easier.