Small practices critical to HITECH success but struggle with EHR adoption

Recent congressional testimony makes it clear: The government’s health IT initiative will stand or fall on the ability of small practices to adopt electronic health records (EHR) and demonstrate meaningful use. The problem is that small practices, where nearly 60% of office-based physicians work, face significant financial, administrative, and legal barriers to technology implementation.

The recent Congressional testimony as well as a

from the Bipartisan Policy Center (BPC) brought home the implications of that issue and how much more needs to be done. The BPC report cites government statistics showing that the percentage of office-based physicians who have at least a basic EHR increased from 16.9% in 2008 to 24.9% in 2010. Growth among primary care doctors was even more robust, jumping from 19.8% to 29.6%.

On the other hand, it’s unclear how many physicians have a system capable of showing meaningful use, or are able to do so. The Centers for Medicare and Medicaid Services (CMS) launched its incentive program on Jan. 1 of this year. Through April 30, 42,614 providers registered for it. (Those seeking rewards through the Medicare program still had to attest to meaningful use to qualify for the incentives, although Medicaid doesn’t require attestation.)

Many physicians still see obstacles to EHR adoption, the report noted. These include lack of financing; lack of a sustainable business model for health IT; implementation challenges; concerns about usability and interoperability of EHRs; and privacy and security issues. The report’s author, Janet Marchibroda, who chairs the BPC’s new Health IT Initiative, calls for additional support to help small practices, community hospitals, and clinics in rural and underserved areas achieve meaningful use.

In testimony before a House small business subcommittee on June 2, Andrew Slavitt, chief executive officer of OptumInsight (formerly Ingenix) suggested that the meaningful use criteria themselves might be one of the main barriers to health IT adoption. While 41% of office-based doctors plan to apply for the meaningful use incentives, and a third plan to do so this year, he pointed out, that still leaves the majority of physicians uncommitted.

After touching on the same challenges that the BPC report cites, Slavitt said, “The greatest barrier is that the decision support and productivity-enhancing capabilities that allow technology to solve simple problems such as connectivity, prioritization, and workflow improvement are not driving the purchase and design of technology. They have taken a back burner to all of the compliance reporting requirements needed to demonstrate meaningful use and qualify for HITECH Act incentive payments.”

He also said that “new product development is focused on satisfying those regulatory hurdles, rather than on simple innovations that improve productivity.”

Other testimony at the subcommittee hearing entitled, Not What the Doctor Ordered: Health IT Barriers for Small Medical Practices, painted an even bleaker picture. Sasha Kramer, a solo dermatologist in Olympia, Washington, said she’d bought an EHR that cost $41,000 (before a state grant of about $20,000) and lost 75% of her productivity during the month it took her to master it. Then, 2 years later, another company acquired her EHR vendor and stopped supporting her system. She estimates it will cost another $27,000 to buy a new EHR. Also, she’ll have to learn the new system all over again.

Farzad Mostashari, MD, national coordinator for health information technology at the Office of the National Coordinator for Health Information Technology, said he had dealt with the EHR woes of many physicians when he led a New York City project to put EHRs in small primary care practices. He testified that despite those challenges, “[EHR adoption] is a rewarding process and ultimately will not only lead to improved patient care and coordinated care but will help those practices succeed financially over the long run.”

While that may be true, something needs to be done to help small practices overcome  financial, legal, and technology barriers to adopt EHRs in the first place, according to the subcommittee chair, Rep. Renee Ellmers (R-NC).

The bottom line: Who is going to help small practices with implementation, as well as ongoing technical assistance? Vendors don’t have enough boots on the ground to handle the load as more and more doctors purchase EHRs. Hospitals, which are helping their employed doctors, and the regional extension centers, which have

so far, may have to play a greater role.

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