An important infrastructure change went on line in the Weems Memorial Hospital emergency room this month, the first component in the hospital’s new electronic medical records (EMR) system.

The provider, CSS, was selected this fall after a request for proposals that narrowed the finalists down to CSS and Healthland.

At the Dec. 3 meeting of the county commission, together with Don Lindsey, chief information officer for Tallahassee Memorial Health Care, and Dr. Pat Conrad, director of the Weems ER, Weems CEO Ray Brownsworth detailed the complicated funding mechanism that should enable Weems to recoup about three-quarters of the expensive price tag of the EMR system.

Brownsworth said the out-of-pocket expenses are about $260,000, and only a portion of $210,000 of this is reimbursable.

“The $210,000 is for other things that include equipment interfaces, connection between software and other pieces and conversion of data for nurses and doctors,” he said.

He said Medicare will pay a portion of the $450,000 cost of software, installation, travel, and training, as well as the $118,000 in annual fees for support and maintenance of the system.

“We will be mandated to have something as we go along,” said Conrad. “Whatever will affect the best transfer of data will help save lives. We won’t immediately make money (but) we will immediately stop a greater loss of money.

“All of these small hospitals nationwide are faced with this,” he said. “I’m not going to advocate buying the most expensive system. A bad system will slow things up. Good modules will allow you with a few clicks to get the correct information (while) a cheap system equals morale problems.”

Chair Cheryl Sanders supported the acquisition, but noted that “I wish we had somebody local instead of bringing somebody in from out of state.”

Brownsworth said the intention is to go in-house with billing in three to five years. As it stands now, CSS is incentivized by making a percentage off the increase in cash payments they are able to collect. He said the deal eliminates about $232,000 in annual costs now going to ARx and Healthland for billing and insurance verification.

“With CSS, we only start making payments for these revenue cycle services once we make more cash than we are right now,” said Brownsworth. “In order for them to get paid, they have to increase the amount of money we get paid, and they then get one-third of the increase.”

Commissioner Pinki Jackel said she wanted to see a report made to the board prior to any payments to CSS. “There are benchmarks we have to hit before approval for government reimbursements,” she said. “I want to be sure we’re meeting benchmarks in a timely fashion.

“We’ve got to do a better job of collecting every penny we can,” she said. If we don’t do a better job, we cannot continue to operate at these losses. (It’s a matter of) the fish or cut bait stage, if we’re continuing to take money out of the trust fund to build a new facility.”

Commissioner Smokey Parrish supported the EMR deal, and agreed the county needed to “get to a point where we quit drawing money out of the trust.

“This is a ‘win-win” of us not having to put up money upfront,” he said, “It’s a way for doctors completing charts in a more timely fashion, which has been a problem in the past.”

Brownsworth said he was not concerned CSS was not yet certified for Phase 2 of Medicare’s electronic health record mandate, since only six vendors on the market are certified as of now.

“That’s more than a year away, in Jan. 2015, and they anticipate to be certified in October or November of 2014,” he said.

The EMR system is expected to go live in the rest of the hospital, the clinics and ambulance system by March 1, 2014, Brownsworth said.

He said advanced registered nurse practitioner Dana Whaley and Dr. Eugene Charbonneau have been seeing about 20 to 25 patients per day at Weems East in Carrabelle, while Weems West has only been attracting about eight to 10 patients per day. He said he expects the clinic’s volume in Apalachicola to rise once renovation is fully complete on Dr. Stephen Miniat’s former offices.