As records go digital, cultures clash
By Sammy Mack
1/21/2010 © Health News Florida
A group of Broward County doctors looking to switch to electronic medical records say the result has been a massive headache: surprise charges, inadequate training and even blocked access to patient files.
For his part, vendor Joe Castranova says that the doctors got exactly what they signed up for and that some still owe him money. He's turned some of them over to collections.
The quarrel is far from over. However it turns out, it highlights some major stumbling blocks as the government promotes electronic medical records as a way to control health care costs. Experts say a culture clash between mid-career physicians and tech-savvy software vendors can translate into mismatched expectations. They tell the buyer to beware.
And with federal incentives now in play, they say there is bound to be further conflict.
“I get upset just talking about it,” said Dr. Arleen Richards, a Plantation physician and one of the doctors who signed a contract with Castranova. "When you look back in retrospect, you’re like, ‘how did this happen?’"
Richards says Castranova promised a cheap, easy piece of software that would increase efficiency in filing insurance claims. The price tag: $10,000 plus the cost of some new computers. The doctor says Castranova also mentioned $44,000 in government grants for implementing the new system, thanks to the American Recovery and Reinvestment Act passed in February last year.
After signing up, Richards learned she would have to pay a $2,500 licensing fee for each provider in her office, to qualify for the stimulus funds. In addition, she said Castranova hit her with almost $15,000 in charges to install new computers--charges she didn't authorize.
Castranova said he doesn’t understand how she could think the computer charges were unauthorized. After all, he said, someone had to let him into her office to install the machines.
"I have nothing to hide," said Castranova. "These doctors are all in a clique together."
He said he was forced to send formal cease-and-desist letters to prevent Richards and the other doctors from calling his other customers and slandering him.
Another of the doctors in a tiff with Castranova, Fort Lauderdale internist Paul Preste claims Castranova didn't provide adequate training after installing the electronic records system.
Preste's office manager, Donna Golden, said there was a day-long training and that Castranova’s employees came to the office on a number of occasions, but she noted some practitioners had to start from scratch after decades of paper records.
"These aren’t doctors who just came out of medical school who know electronic charts—these are 60-year-old doctors," she said.
Preste also complained that he received only one of four licenses he paid for, to qualify for stimulus funds.
"I owe him three, that’s true, but he owes me money; when he pays his bill, he’ll get them," Castranova said. He views the remaining licenses as leverage on Preste’s outstanding bills—money Preste contends he does not owe.
No agency tracks electronic medical records disputes, but experts said feuds like these are not uncommon.
"The two biggest complaints you’ll get from physicians is that ‘It cost way more than I thought it would,’ or, ‘It works way slower than paper,’" said Tracy Maxwell of Maxwell IT, a health software consulting firm based in Seattle.
More and more physicians are being lured to medical charting software by government incentives. The American Recovery and Reinvestment Act earmarked $20 billion for a health information technology initiative, which in turn rewards physicians for switching to electronic medical records. The grants are up to $44,000 if doctors accept Medicare patients, and up to $65,000 if they take Medicaid patients.
But not all medical practitioners understand the costs and time involved, Maxwell said.
"You don’t just load ‘em and get started," she said. She added that doctors are often surprised to learn mastering a system takes months—even a year.
"I think they need a course in computers" before attempting to learn electronic charting, says one of Castranova’s trainers, Michael Mitchel. Some of the doctors seemed scared of using the mouse, he said.
Castranova founded his electronic medical billing business in South Florida nine years ago. He said he saw potential growth in electronic patient records after a presidential healthcare debate in 2008. That's when he became a reseller for Spring Medical Systems, makers of the SpringCharts EMR software.
"We’ve been working with Joe for over a year and we haven’t heard any problems until the last three months," said Spring Medical Systems CEO Jack Smyth.
When Smyth has asked the disgruntled doctors to see contracts or documentation of wrongdoing, he said, "they can’t produce them."
In another complaint against Castranova, Dr. Linda Kaplan said she too was surprised by charges on her invoice. When they first met, Castranova recognized her as a former medical editor at the local NBC television affiliate. She said he offered to waive her software and training fees if she would endorse the product.
Kaplan agreed, but she said she was unimpressed with the system once it was installed in her Hallandale Beach office. She was reluctant to drum up business when she wasn't a satisfied customer.
Kaplan said Castranova was displeased with her lackluster endorsement and locked her out of some 600 patient records on his server. He billed for the software system anyway.
Castranova said he gave her four months’ notice before locking her out—plenty of time to retrieve patient files.
He confirmed he charged Kaplan for services that he originally offered for free. He argues that Kaplan didn’t bring in any business, and so violated her part of the sponsorship contract.
Maxwell, the software consultant, said doctors can avoid some of the grief by thoroughly researching their options before buying an electronic records system. She encouraged medical offices to shop around and set a five-year budget that includes the cost of scrapping a system if it doesn't work out.
Draw up an exit strategy for retrieving data if something goes wrong, she counseled. And get expert help reviewing contracts.
Linda McMullen of the Florida Medical Association said she's starting to hear similar stories of spats between doctors and software vendors.
"The people that have had problems just went out and bought one (electronic medical records system)," she said, as opposed to researching the software and the company behind it.
--Sammy Mack is an independent journalist in Miami.