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GREENSBORO — Proud parents Josh and Jennifer Smith of Randleman have brought their 4-day-old son, Wyatt, to the doctor’s office for a checkup.

Dr. Chris Van Winkle, one of 10 physicians at Carolina Pediatrics of the Triad in Greensboro, examines Wyatt and makes notes by touching the screen on a laptop computer. He counsels the Smiths on Wyatt’s care, right down to what color poop they should be finding in his diaper (sort of yellow, now that he’s breastfeeding).

After the parents leave, Van Winkle uses the mouse clicker and a stylus to enter additional information into the laptop, including notes on his talk with the Smiths. He can order tests if he needs to, and the software, prompted by one abbreviation, offers a list of topics, improving Van Winkle’s efficiency.

The information he enters can be used by others at the practice for scheduling follow-up appointments and documenting insurance claims.

Van Winkle and his colleagues at Carolina Pediatrics are part of a movement toward electronic health records.

Members of that movement say such systems will reduce costs, improve efficiency and reduce medical errors. But change has been slow in coming because some physicians, particularly those in small practices, say the systems are too expensive.

Reducing errors is particularly important in the U.S., say medical professionals and health advocates. The country spends a larger share of its economy on health care than any other industrialized democracy but lags behind 14 of those countries in preventable deaths, according to the journal Health Affairs.

When Van Winkle is on call, he can access a patient’s records from home on a computer, making treatment faster and better.

Electronic records also can improve patient care by, for example, alerting doctors or nurses to possibly harmful drug interactions, among the most common types of medical errors.

They can flag when a patient has missed a vaccination or when a doctor or nurse hasn’t carried out a preferred practice in treatment, such as giving heart-attack patients aspirin.

And, with various systems networked, they can help in coordinating care for a patient who sees multiple doctors, as well as offering wider and more detailed research into what drugs and treatments work best.

The subject has attracted attention at the highest levels of government: President Bush called in 2004 for every American to have an electronic health record by 2014, and the Department of Health and Human Services has created the Office of the National Coordinator for Health Information Technology to address that and related issues.

Backers believe such systems could save money. A study by the Rand Corp., a nonprofit think tank, suggests that about $77 billion in U.S. health care costs annually, out of more than $2 trillion total, could be saved by widespread adoption of electronic records. A 2005 study published in Health Affairs cited a similar figure, $81 billion.

After installing its system, Carolina Pediatrics changed one full-time position from handling paperwork to more direct patient care, Van Winkle says. And the practice reduced its printing costs by half within a year, says administrator Kellie Venable.

But a study released in May by the nonpartisan Congressional Budget Office concludes that the savings won’t be as big as Rand and other proponents think: “Office-based physicians in particular may see no benefit if they purchase (an electronic-records system) — and may even suffer financial harm.”

One reason, the study found, is that an insurer or patient might see savings, but not the doctor.

Only about 17 percent of American physicians have such systems, according to a study published in July in the New England Journal of Medicine. Thirteen percent more had bought systems but had not begun using them.

A separate study, released in September by the Center for Studying Health System Change, found that only 29 percent of U.S. hospitals provide money or technical support for doctors to adopt electronic medical records.

Moses Cone Health System is offering to pay 85 percent of up-front license fees and implementation charges for physician practices that qualify as affiliates of Moses Cone, said John Jenkins, a Moses Cone vice president and chief information officer.

Fees vary based on the number of physicians in a practice, the number of locations of that practice and the number of people besides physicians who have access to the system, Jenkins said.

But for a typical physician in a one-doctor practice, the licensing and implementation fee would be more than $36,000, with Moses Cone paying about $31,000 of that. New computers aren’t included.

Carolina Pediatrics’ startup cost, primarily for computers, was “in the upper 300 (thousand) range,” Venable says.

Practices also must pay their own support and maintenance fees, starting at about $5,500 annually for a solo practitioner, Jenkins said.

Figures such as those have kept many practices from making the switch, even with benefits taken into account.

“It is troubling to see just how slow physicians are moving to adopt this technology,” Dr. David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital and co-author of the study, told Health Affairs. “We need to get moving a lot faster than we have been if we are going to take full advantage of this technology and realize its promise for medicine.”

Cost is the main issue just down Henry Street from Carolina Pediatrics, where Dr. Richard Aronson and his seven colleagues at Guilford Medical Associates still use paper medical records.

They probably will stick with paper until the government or insurers force them to change, Aronson says.

Even then, the government or insurers probably will have to provide financial help, because the start-up, maintenance and licensing fees may be more than his practice, and many others, can absorb.

“The problem for us is that 60 percent of our practice is Medicare, and Medicare (reimbursements have) been flat for 10 years” while costs rise steadily, he says.

To pay for an electronic system, Aronson says, “you’ve got to cut costs, see more patients or suck it up.”

Guilford Medical uses electronic systems to handle such needs as appointments and insurance claims. But to change medical records, Aronson says, Medicare will have to give practices money or increase reimbursements for treatment. Otherwise, he said, a mandate could mean the practice would stop accepting Medicare patients.

Medicare, whose lead many private insurers follow, already has begun using incentives and penalties in the limited area of electronic prescribing, which both Carolina Pediatrics and Guilford Medical practice.

Medicare is offering small bonuses to doctors who order prescriptions electronically between 2009 and 2013. But Medicare will reduce its fees slightly for doctors who aren’t prescribing electronically by 2012. Currently, only about 7 percent of prescriptions in the U.S. are filed electronically.

And to help cover electronic-record startup costs, Medicare’s parent, the Department of Health and Human Services, announced in June that it would spend $150 million over five years to help doctors in up to 1,200 small practices adopt electronic records.

The CBO report points out another reason money may figure into whether practices make the change. If such systems reduce duplication in tests, for example, practices will make less money from tests.

And Aronson thinks using laptops is not very patient-friendly.

“I look at the chart before I go in the room, then I talk to the patient and make decisions, as opposed to having a touch screen while I’m with a patient,” Aronson says. “The patient wants you to look at them while you’re talking and listen to them, not just to transcribe.”

Aronson also expresses concern that adopting electronic records could actually decrease productivity, at least while the practice gets acclimated to a sophisticated system.

Van Winkle said it took between six and 12 months for Carolina Pediatrics to get up to speed on its new system.

“It was definitely hard to transition from a paper chart to a computer chart,” he said, “but having gone through that transition, I wouldn’t go back.”

Contact Lex Alexander at 373-7088 or lex.alexander@news-record.com