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Feb 09

For Small-Practice Physicians, HIT Benefits Now Are Within Reach.

For Small-Practice Physicians, HIT Benefits Now Are Within Reach

Graph: Top Barriers to EHR Implementation

Historically, adopting health information technology (HIT) has been a challenge for small group physician practices – those with 10 or fewer doctors. Cost and complexity have been formidable barriers to small practices, particularly for their small business owners who already operate on thin margins.

Perhaps what physicians have feared the most when considering HIT implementation is the potential of disrupting the operations of the practice and, ultimately, the impact on patient care.

Fortunately, recent trends may signal a sea change. Innovation on the part of HIT vendors has begun to reduce the costs of billing and electronic health record (EHR) systems. In addition, the ubiquity of the Internet means these tools can be implemented, updated and accessed more simply and easily. And today, there are significant financial incentives to encourage physicians to consider adopting HIT, even in the smallest practices.

Technology and ARRA spur fresh look at EHRs

Kim LaFontana, Vice President of Strategic Initiatives, Ingenix“Primary care practices – even those with five or fewer doctors – have several new reasons to reconsider their past EHR decisions,” said Kim LaFontana, vice president of strategic initiatives, Ingenix. “One reason is that payers are raising the bar with pay-for-performance and other measures that require doctors to track or demonstrate compliance with clinical guidelines. This cannot be accomplished easily or efficiently with paper records,” she said.

Further, “patients are demanding that their physicians have electronic access to their information,” added Tony Frankos, vice president for business development at Ingenix. “Patient retention may soon be an issue if physicians fail to make the move.”

Two additional factors that are making electronic systems more appealing to physicians include the emergence of new technologies and the availability of federal funds for HIT implementation. “Very few small-practice physicians have had much interest in legacy vendor solutions. The first issue is cost – typically an upfront investment of between $60,000 and $100,000 – and then significant annual maintenance and upgrade fees. The next issue is that legacy solutions require the physicians to install and maintain network servers, an expensive and challenging situation,” LaFontana explained.

“And finally, after all that cost and disruption, many physicians who implemented legacy solutions actually saw decreases in both productivity and income,” she observed, which slowed them down so they saw fewer patients and made less money. “But now that low-cost, Web-based EHRs exist, implementation has become far less daunting and significantly less expensive.”

The American Recovery and Reinvestment Act of 2009 (ARRA) provides physicians with incentives to modernize their practices. Specifically, the ARRA allocates $19 billion for health care information technology1 — including Medicare incentive payments of up to $44,000 over five years to eligible physicians who meet “meaningful use” criteria for integrating EHRs into their practices. If physicians fail to adopt and demonstrate meaningful use of EHRs, they will be subject to reductions in Medicare reimbursements at the end of the five-year period.

“The good news is that even though the funds being offered under ARRA are not enough to pay for legacy solutions, they are more than adequate for the implementation of a Web-based EHR system,” LaFontana noted. Physicians need to take a new look at the solutions that are available right now so they can take advantage of federal funds; under the ARRA, practices have to demonstrate meaningful use by the end of 2010 to be eligible for incentive payments in 2011.

To successfully make the switch, “physicians will need to devise effective roadmaps for going from paper-oriented systems that they may think work for their practices to more efficient electronic systems that deliver an improved workflow and support their efforts to enhance patient care,” according to LaFontana.

Problem recognition is first step in EHR strategy

One of the first things that physicians need to address when examining their EHR strategies is whether HIT solutions will make their practices more efficient and result in better patient care. “Many practices believe that their paper systems truly are effective,” Frankos explained, “and this can be a tough mental barrier to overcome.”

LaFontana concurred, adding that practices “have built up very systematic ways of getting through their work day. They may handle critical information like ‘stat’ lab results via paper ‘sticky notes’ – a process that would be substantially more effective if technology were applied to improve speed and workflow. Practices can be so entrenched in their current processes that they fail to recognize the opportunity provided by ARRA funding.”

A lack of familiarity with ARRA provisions may be a missing piece of the EHR puzzle. A recent Ingenix survey of physicians and practice administrators showed that more than half of the respondents have “little or no” familiarity with the ARRA and only 42 percent of respondents have “some” familiarity with ARRA provisions. This finding is significant, because federal funding under the ARRA goes a long way toward helping physicians with the burdensome cost that 82 percent of respondents cited as their top concern regarding EHR adoption.

“Primary care physicians are facing increasing costs and decreasing reimbursement, so they can’t really afford to pass on the chance for EHR funding or to suffer from reduced reimbursement amounts in five years because they failed to act today,” said Frankos.

Building a blueprint for HIT implementation

Modernization of the nation’s health care system will depend on physicians taking action with regard to EHRs. Although small physician practices provide nearly 75 percent of all ambulatory care in the United States,2 only about 13 percent of small and solo practices have implemented an EHR system,3 compared with 57 percent of physicians in practices with more than 50 doctors.

These statistics underscore the need to offer extra assistance to small-practice physicians. To determine precisely what physicians are up against, Ingenix is developing a blueprint for what a successful EHR transition “feels like and looks like,” LaFontana said. “We want to focus on the realities of the small physician office and see how change management and best practices can be integrated for a smoother electronic office transition.”

The outcome, says LaFontana, will be a replicable guide for small physician practices through otherwise complex processes for selecting, installing and adapting to new technologies. “We intend to illustrate the best-case scenario for HIT implementation – which includes evidence-based medicine, e-prescribing and EHRs – and show, through case studies and both qualitative and quantitative data, what it takes to achieve that,” she said.

LaFontana noted that Ingenix has partnered with select small physician practices for a pilot program, providing them with licenses to CareTracker EMR, a CCHIT-certified,4 Web-based EHR application that allows physicians to access patient records and review medications, patient history, recent orders and test results with speed, agility and efficiency.

“We intend to illustrate the best-case scenario for HIT implementation – which includes evidence-based medicine, e-prescribing and EHRs – and show, through case studies and both qualitative and quantitative data, what it takes to achieve that and what can be gained: savings, better patient care and satisfaction, and better access to critical healthcare information,” according to LaFontana.

“Ingenix is not underestimating the difficulty these offices face in moving to an electronic platform,” LaFontana said, “but we want to show how practices can get there. Primary care doctors, especially those in small practices, want to be successful, remain independent and deliver excellent patient care,” she said. “We are advocates for physicians and are seeking ways to make their lives better by partnering with those who share our goal,” she added. “Ingenix has a vision for the future and we are actively investing in ways to transform health care in a positive way.”


1 American Recovery and Reinvestment Act of 2009, H.R. 1, Title XXX, Sec. 3001.
2 Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 Summary. National health statistics reports; no 3. Hyattsville, MD: National Center for Health Statistics. 2008.
3
Catherine M. DesRoches, Dr.P.H., Eric G. Campbell, Ph.D., Sowmya R. Rao, Ph.D., Karen Donelan, Sc.D., Timothy G. Ferris, M.D., M.P.H., Ashish Jha, M.D., M.P.H., Rainu Kaushal, M.D., M.P.H., Douglas E. Levy, Ph.D., Sara Rosenbaum, J.D., Alexandra E. Shields, Ph.D., and David Blumenthal, M.D., M.P.P, (Electronic Health Records in Ambulatory Care— A National Survey of Physicians), N Engl J Med 2008;359:50-60.
4 CCHIT (The Certification Commission for Healthcare Information Technology) confirms that Ingenix CareTracker, Version 6.2 from Ingenix is a CCHIT Certified Ambulatory EHR product for 2007.

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