The NextGen electronic medical records system in use at Powell Valley Healthcare still is causing headaches, and those headaches are likely to get worse before they get better.

While a team from NextGen has made some progress in correcting interface and other problems with the $2 million system purchased two years ago, significant difficulties remain.

Bill Patten, chief executive officer for Powell Valley Healthcare, told the PVHC board last week that he still is trying to work with the company to resolve the remaining issues, but his patience is growing thin.

“I’ve told Jonathan (Isaacs, vice president at NextGen Healthcare) I don’t want us to become the 19th hospital that’s suing them,” Patten said at a Sept. 30 board meeting. “We’re trying to hold NextGen’s feet to the fire, while at the same time recognizing that there may come a point where we say enough is enough.”

For the first time since the troublesome system was installed, initially in July 2012, Patten talked about the eventual possibility — one he’s not enthusiastic about — of ditching NextGen and looking for a better electronic medical records system.

“At some point, we decide we’ve struggled long enough and start talking about life after NextGen,” he said.

But, even if that were to occur, the subsequent search for a new company and the time needed to negotiate and implement a new system could take up to two and a half years.

“We would have to use NextGen during that whole time,” he said, so it would be much more beneficial to work out the problems with NextGen, if possible.

Adding to that dilemma is the fact that Powell Valley Healthcare needs to achieve the second level of meaningful use, as defined by the federal government, in order to qualify for a total of $300,000 in federal incentive payments over the next three years. For each doctor using the system, Powell Valley Healthcare will receive $12,000 this year, $8,000 next year and $4,000 in 2016.

That incentive money was included as part of the payment plan put together by interim Chief Executive Officer Mike Lieb in November 2011 for purchasing the system. That took place prior to Patten’s arrival in February 2012.

NextGen was selected previously by a Powell Valley Healthcare committee assigned the task of choosing a new electronic medical records system. The committee was comprised of PVHC doctors, nurses, administrators and staff.

In order to meet meaningful use, medical providers at the clinic must be fully using the NextGen system, Patten said.

During the meeting, Dr. Mike Tracy, who serves on the Powell Valley Healthcare board, said using the system will reduce the number of patients he can see in a day because of difficulties with NextGen, and that will affect the organization’s bottom line and increase wait times for patients. He asked if it would make more sense to forego the incentive money this year in the hopes that it will be more user-friendly in the future.

Patten said that is problematic too, because meaningful use must be established this year in order to qualify for incentives for all three years.

“If we don’t hit this current 90-day window (for $12,000), we will automatically lose out on 8 and 4” for 2015 and 2016 respectively, Patten said. “Secondly, if we don’t attest to meaningful use, we will begin to see penalties up to 5 percent.”

The incentives are the “carrot” used by the government to encourage hospitals to use electronic medical records systems. After that, penalties set in, he said.

The federal government encourages the use of electronic medical record systems, also known as health information systems, to make patients’ health information available quickly, with no delay for transcription, and transportable to other medical providers and specialists when needed.

Board President Dr. Mark Wurzel said he is frustrated by extra returns built into NextGen programming, because they waste his time by requiring him to make many unnecessary keystrokes. And if he is interrupted in the process and the program times out, that means more wasted time.

Patten said industry surveys indicate converting to electronic medical records systems does increase appointment times and decrease the number of patients seen, especially at the start. As providers become more efficient in using them, appointment times decrease, but they still remain longer than they were before.

Mike Gilmore, vice president of outpatient services, said some providers have used the system all along, while some used it sporadically.

As of the end of September, 85 percent of doctors were using the system, he said.

“We have had a lot of physicians starting the system within the last week,” he said. “A few more need to get going on that full time; some are not 100 percent yet.”

To qualify for meaningful use, doctors must have 50 percent of their patients on the system by Dec. 31, Gilmore said.

“They still can meet that goal,” he said, “it just means that they have to have more than 50 percent if they delay.”

Meaningful use is based on each doctor’s use of the system and does not require 100 percent participation to qualify for incentive payments, Gilmore said.

“They’re doing good,” he said. “They’re a really good team. These docs are the best ones I’ve ever worked with.”