Two things you're less likely to see in a doctor's office nowadays are a pad and a pen. As part of a nationwide initiative, many of the 4,000 doctors who practice in Maine have switche--or are in the process of switching--to a system whereby all patient records are stored electronically. This move toward electronic health records, or EHRs, is being strongly encouraged by the federal government, which is offering incentives for doctors to adopt them. Supporters say the new system, when fully implemented, will cut costs, reduce errors, and most importantly improve the quality of patient care. And it will eliminate the frustration of trying to decipher the scrawls found on many hand-written doctors' notes. However, not everyone in the profession fully agrees with the move.

"The record keeping on an electronic record does not make for better medicine, it does not make for better medical decision-making, at least the way the software is devised now," says Dr. James Raker (left), who has been practicing as an independent physician in Brunswick for 24 years, specializing in internal medicine.

He's one of a dwindling band of solo practitioners--doctors who operate on their own and not as part of a larger medical group or health clinic. About 400 of Maine's 4,000 licensed physicians fall into this category. Raker says he began electronic record-keeping at beginning of 2011 because he feels this is the way the industry is inevitably going.

Nevertheless, he says electronic records are more time consuming than the old method, and do nothing to help the patient. He cites the example of a patient who has trouble breathing and comes to see him with a suspected chest infection.

"So I take their temperature and then I walk back to the table where a piece of paper used to be, which was part of their chart, where I would put in their temperature--you know it doesn't take much to write down 98.6--but now I have to go back, sit on my stool, make sure my computer hasn't fallen asleep, jiggle the mouse, find the box where 98.6 goes, then stand back up again, say 'Where was I? Ah, yes, now I need to look in their throat,'" he says.

Not that Raker is against electronic health records, per se. A big part of the problem he says, is that in many cases the EHRs of different healthcare organizations cannot communicate with each other, something which he says leads to the inefficiencies and duplication that they're supposed to prevent.

He cites the Veterans Administration hospital system as a positive example of how it could work. Years ago the VA digitized all its medical records, enabling easy access to patient records at any VA hospital in the country. Raker says EHRs are also having a positive impact in hospitals, and he should know: In addition to his primary care practice, Raker also works several days a month as a hospital doctor, or hospitalist, at Central Maine Medical Center in Lewiston.

"A well-run hospital, with an electronic record that has electronic order entry, has been a boon to patient care, has improved patient care, has improved patients outcomes and is a completely different world," he says.

According to an analysis by Reuters, the use of EHRs among office-based physicians nationwide nearly doubled last year to 41,000--that's 34 percent of all doctors in the U.S. A similar increase in hospital use was also reported, with nearly 2,000 of them now "gone electronic."

The federal government is pulling out all the stops to make electronic medical record-keeping the norm in years to come. Under the stimulus act of 2009, doctors are being offered incentives of between $44,000 and $65,000 to convert to EHRs for the treatment of patients on Medicare or Medicaid, providing they can demonstrate what's termed "meaningful use."

There's an element of coercion here too: Those who haven't complied by 2015 face penalties in the form of cuts to their federal reimbursements.

"You can lose one percent, two percent, three percent of your Medicare revenue if you haven't adopted an electronic medical record and complied with the terms of meaningful use--it's getting to the point of the stick instead of the carrot," says Gordon Smith, executive vice-president of the Maine Medical Association, which favors electronic health records but at the same time recognizes the difficulties faced by some doctors as the transition is made.

"It's a big change, and it's a cultural change and it will take some time for the system to get there," Smith says. He admits that for many of Maine's solo, independent practitioners, converting their entire collection of paper records into an electronic format is a daunting prospect.

Dr. James Raker agrees. "And the last thing you want to do at 7 o'clock at night after you've been seeing patients all day and hoping to, you know, take your kid to swimming or band or something, is to start converting an office like mine with 4,000 patients and 23 years worth of data," he says.

Raker (who's secretary, Lisa Andrews files folders in photo at left) says this is one more reason why some in private practice are either seeking early retirement or looking for employment with bigger healthcare groups, where they have a larger staff and more infrastructure to support them.

Dr. Paul Wooden is an independent practitioner in Farmington. He uses electronic health records and finds them helpful.

"They excel in terms of data capture, of making records available, keeping track of medication lists, allergy lists," he says. "They have the ability to check a patient's allergy list based upon medicines that are prescribing, so that's a real benefit."

As the medical industry gets more complex and more costly, Wooden says EHRs are the best way to go, although he admits they are causing some growing pains. One negative side effect, he says, is that visits to the doctor have now become less personal. "In a given 15-minute appointment it's more and more challenging to give the patient the time that they really deserve," he says.

The challenge for doctors, he says, is to be a good advocate for each patient's needs without becoming distracted by technology.

Photos by Tom Porter.