As the staff at a small Presque Isle health clinic prepared to see patients one day in July, they stopped short at their keyboards.
They soon realized they’d been locked out of the electronic health records for all of their 3,500 patients. Stuck behind a virtual wall, the records — digital medical histories detailing everything from blood pressure readings to medication lists and lab results — might as well have disappeared.
The vendor that maintained the records had taken the uncommon step of denying access because of a longstanding billing dispute with the practice, Full Circle Health Care.
CompuGroup Medical, a German firm with U.S. headquarters in Boston, showed no regard for the safety of the practice’s patients, said E. Victoria Grover, a physician assistant who runs the independent practice.
“They screwed us and I hope somehow they have to face the consequences,” said Grover, who first shared the story with The Boston Globe.
CompuGroup blocked the clinic’s 10 employees from a critical tool that medical providers rely on more than ever in treating patients. Electronic health records have been hailed as a way to improve health care by putting patient histories at clinicians’ fingertips, their adoption spurred by $30 billion in federal stimulus funds.
Doctors and nurses log nearly every interaction with patients in the records, aiming to prevent medical errors and dangerous drug interactions and better coordinate care.
Much of the debate around electronic health records has centered on their potential to improve care, patient privacy and the security of data. But possible pitfalls stemming from the legal relationships between vendors and health providers have gotten less attention.
In the wake of the rapid proliferation of electronic health records, similar disputes are likely to crop up, in Maine and across the country, according to Kate Healy, a partner in the health care group at the law firm Verrill Dana.
“I think this is probably the start of a new trend,” she said.
Eager to get the records online, vendors and providers signed contracts without always thinking far enough ahead, Healy said. Some overlooked how to proceed when things go south, she said, such as when a vendor or provider shuts down or a payment dispute arises. With more vendors jumping into the market, problems are bound to crop up, Healy said.
“When you switch vendors or terminate contracts, you’re going to have issues like those raised in this case,” she said.
At least one other health provider in Maine has been shut out of its patients’ electronic records. Earlier this year, a different vendor denied access to a small Freeport-area practice following a billing dispute, according to Gordon Smith of the Maine Medical Association. The vendor reportedly entered the practice’s office under the guise of updating or servicing the records system, then switched off the provider’s access, Smith said.
Healy said she’s working with a medical group in Massachusetts that encountered a situation similar to Full Circle’s.
It remains unclear how many health-care organizations CompuGroup serves in Maine. A company attorney didn’t respond to a request for comment from the Bangor Daily News.
At least five primary care practices in the state used CompuGroup as of about two years ago, according to a limited survey by HealthInfoNet, the state’s health information exchange. Another seven practices were clients of HealthPort, a vendor CompuGroup later acquired.
Under Maine law, health providers own the medical records they maintain, not patients, Healy said. Patients have a right, under both state and federal law, to access their records through their health provider and request a copy.
So while Full Circle legally owns the locked records, its right to actually get its hands on them remains contingent on the practice’s contract with CompuGroup, she said. Hospitals and medical groups typically enter agreements with vendors that outline the return of medical record data upon termination of the contract, Healy said.
“The provider owns the medical record, but it’s a matter of getting the record,” Healy said. “If the record is maintained somewhere else, it becomes kind of tricky.”
In Full Circle’s case, the patient records live on a server the practice owns and houses on site. CompuGroup shut off access remotely, leaving the medical histories physically within reach but ultimately inaccessible.
Full Circle initially signed a contract with Healthport, agreeing to pay $300 to $600 a month in maintenance fees after an initial $72,000 investment, Grover said. After CompuGroup acquired the company 18 months later, the bill shot up to $2,000 a month, she said.
Over the following two years, CompuGroup billed Full Circle for delivery and maintenance of equipment the practice never received and withdrew money from Full Circle’s bank account while allegedly failing to document its charges, Grover said. Meanwhile, the company charged up to 30 percent interest on the disputed balance, she said.
Full Circle went back and forth with CompuGroup, which never acknowledged or corrected the errors, Grover said.
Last fall, Grover told the company she’d stop making payments until CompuGroup provided invoices, she said. CompuGroup soon warned Full Circle it would block access to the records unless the practice paid $20,000, Grover said.
She spoke to the company’s head of accounting, who said he’d look into the matter and get back to her, she said. Two weeks later, following no further communication, the records were locked, Grover said.
CompuGroup told the Globe that Full Circle resisted its attempts to negotiate a settlement of the outstanding bill, likening its action to an electric company shutting off a consumer’s power after a year without payment.
Now, the practice simply wants 48-hour access to the records to move them to a new system, Grover said. Full Circle has since signed on with another vendor, Athenahealth Inc., which has offices in Belfast.
“As a mission-driven company, we believe our clients have a right to their data,” Matthew Hoenigsberg, Athenahealth’s manager of product marketing, said in a statement. “Therefore, if a client wishes to leave Athenahealth for any reason, we provide them with a copy of their data at no additional charge.”
Full Circle has scrambled to reconstruct the records, piecing information together through conversations with patients and phone calls to hospitals and outside physicians, Grover said. But patient histories from the the last three years remain stuck in the computer servers, mostly measurements taken in the office, such as patients’ weights and blood pressure readings, she said.
“Thank heavens I never shred anything,” Grover said. “I have paper charts going back 25 years.”
Aside from jeopardizing patient safety, the records block prevents Full Circle from accessing information about patients’ out-of-pocket medical expenses, which many need to verify their eligibility for disability payments and subsidized fuel for winter heat, she said.
Grover’s weighing a lawsuit against CompuGroup, but hopes the state attorney general’s office will step in on her behalf. Her lawyer advised her that she wouldn’t see the records for at least a year if she sued the company, she said.
Grover said she expects CompuGroup didn’t expect a small practice in northern Maine, which receives no ongoing financial support from the federal government or a big hospital system, to challenge its unfounded charges.
“It’s a sign that the health care system is so awash in fraud and abuse that nobody cares if the bills are inflated,” she said.
