FIAT DEALERS GARAGES

* In Virginia, Romney changes the subject from immigration

* "We are going to get rid of Obamacare," Republican says

By Tim Reid

SALEM, Va., June 26 (Reuters) - Republican Mitt Romney stepped up his criticism on Tuesday of President Barack Obama's signature domestic policy achievement, saying if the U.S. Supreme Court does not overturn the 2010 healthcare overhaul when it decides its fate this week he would dump it if elected in November.

Eager to change the subject back to Obama's economic stewardship after nearly two difficult weeks focusing on immigration, Romney accused Obama of taking his eye off the ball when he pushed the healthcare measure through Congress in 2010.

"Instead of focusing on the big issue, the economy, he focused on his healthcare reform, called Obamacare," Romney, set to challenge the Democratic president in the Nov. 6 election, told a crowd at a machinery manufacturer in Salem, Virginia.

At the mention of "Obamacare" - the derisive nickname critics have given the law - the crowd erupted in boos.

The Supreme Court is scheduled on Thursday to rule on a legal challenge posed against the law by 26 of the 50 U.S. states and a small business trade group that argued the measure violates the U.S. Constitution.

Romney said if the high court justices deem the law unconstitutional, "then the first three and a half years of the president's term will have been wasted on something that has not helped the American people."

"If it stands, we are going to get rid of Obamacare and I'm going to stop it on day one," Romney added.

The 2010 law, which constitutes the U.S. healthcare system's biggest overhaul in nearly 50 years, sought to provide health insurance to more than 30 million previously uninsured Americans and to slow down soaring medical costs. Critics say it meddles in the lives of individuals and in the business of the states.

The justices could uphold the law, strike down certain provisions or overturn the whole thing.

Romney enacted healthcare changes as governor of Massachusetts that bore similarities to the law Obama signed. But Romney argues that the federal law is killing jobs.

Romney's aides on Tuesday circulated a report, first published last year, in which a medical device manufacturer asserted that the 2010 law would cost the company so much in additional overhead costs that it might have to ship thousands of jobs overseas.

IMMIGRATION POLICY

Romney in recent days has been tied up with the issue of immigration and has struggled to lay out an immigration plan.

He appears to have been caught flat footed by Obama's announcement on June 15 that hundreds of thousands of illegal immigrants who were brought into the United States as children could be able to avoid deportation and get work permits. Most illegal immigrants in the United States are Hispanics.

In response, Romney accused Obama of political motivation in making the policy change, but declined to say he would repeal it if elected.

Romney also was cautious in reacting to Monday's Supreme Court ruling upholding a portion of Arizona's state crackdown on illegal immigrants while striking down other parts of the law.

Looking more comfortable on Tuesday, Romney stood in front of a banner stating, "Putting Jobs First." "Do you think Obamacare is working just fine to get the American people back to work?" he asked people in the crowd. "No!" they yelled back.

Romney's own record on job creation was challenged by Vice President Joe Biden, who accused him of devastating entire communities as a private equity executive in the 1980s and 1990s who shipped U.S. jobs abroad.

"Like so many other things the governor talks about, there is a huge disconnect between what he says and what he means and what he's done," Biden told supporters in Iowa, referring to Romney's time as head of the investment firm Bain Capital.

Citing a Washington Post report, Biden said Romney's former firm helped move American jobs overseas.

"They made a great deal of money facilitating this outsourcing and offshoring American jobs. Yeah, they made a lot of money. But in the process they devastated - they devastated - whole American communities," he said.

Obama and Romney are running close in opinion polls, with a PPP survey in the battleground state of Ohio showing the president with a lead of 3 percentage points, down from 7 percentage points a month ago. (Additional reporting by Laura MacInnis in Washington; Editing by Will Dunham)

The technology is being introduced with the goal of decreasing errors and streamlining patient care. But some researchers have worried that in transitioning to electronic records doctors could make more mistakes using new and unfamiliar systems - such as writing notes and prescribing drugs in the wrong patient's record.

"Electronic health records and other health technology, while there's a general belief that they're helpful… there's also been concern that these same systems can predispose to unrecognized types of (errors) and unsafe events," said Dr. Steven Simon, from the VA Boston Healthcare System.

He and his colleagues found, however, that using electronic health records (EHR) was tied to an 84 percent lower chance of getting sued. Their study was published Monday in the Archives of Internal Medicine.

"If nothing else, these results should be reassuring to physicians and to practices that there's a very, very little chance that EHRs and EHR adoption would increase their chance of malpractice claims," Simon told Reuters Health.

One researcher not involved in the study cautioned, though, that doctors may have to wait to see the longer-term effects of electronic records on malpractice suits - including whether the technology allows more medical decisions to be scrutinized in court.

Simon estimated about one-third of practices are currently using electronic health records, which allow different doctors treating a single patient to access each other's notes and see what medications the patient has been prescribed.

More advanced systems also warn doctors if they're about to prescribe a drug that may interact with other medications a patient is taking.

For the new study, Simon and his colleagues surveyed 275 Massachusetts doctors in 2005 and 2007 about if and when they had adopted electronic health records and compared that to medical malpractice claims against those doctors starting in 1995.

Thirty-three of the participating doctors had been sued. The researchers calculated 49 claims before electronic records were adopted, including 13 resulting in a payment, and two claims after, neither leading to a payment.

"Electronic health records in general tend to improve the quality of care by decreasing the number of mistakes, and to the extent to which mistakes drive malpractice claims, you should be seeing less claims," said Dr. Sandeep Mangalmurti, who has studied health technology and malpractice at the University of Chicago.

Still, he said, there might be a period while the electronic records are being introduced that more mistakes could happen.

"There's no question there are kinds of errors that get introduced - and they're solvable," said Dr. Brian Strom, who has also studied electronic health records at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

"What we need to do is, we need an iterative process that develops the product, identifies the errors, fixes the errors and keeps testing," said Strom, who wasn't part of the research team.

Aside from the impact on medical errors, Mangalmurti said in the long run, lawyers may use data from electronic health records in court, which could also make doctors more vulnerable to malpractice suits.

"Suddenly there's a lot more information available for scrutiny," Mangalmurti, who also wasn't involved in the new study, told Reuters Health. "Everything a physician does is now theoretically accessible by everyone," he said - such as how long doctors spend looking at a patient's records, or when they add or make changes to notes.

The new research "is beginning to show what we expected, which is that at least in the short term, in this limited context, EHRs may help physicians," Mangalmurti said. "I think the jury's still out about the long-term effects."

Researchers said worries over malpractice suits probably aren't delaying the implementation of electronic health records as much as the initial costs of using them and the extra burden for doctors and nurses learning the systems.

"I don't think there's so much of a concern about the unintended consequences and risks," Simon said. "It's more about change."

SOURCE: bit.ly/QceVBj Archives of Internal Medicine, online June 25, 2012.