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Written by David Lee Scher, MD, FACP, FACC, FESC, FHRS for Healthcare IT News Blog
By all accounts, the current status of adoption of EHR in the USA is slower than anticipated by the government. There are multiple reasons both from the mandate side and the provider side.
Small practices are finding financial and administrative issues which are stopping them from implementation. These practices make up upwards of 60% of office-based physicians. The outlay per primary care physician from one study estimated the cost per physician (including the purchase and lost productivity during training) was $47,000. This is less than the total Medicare incentive payment per physician.
The current estimate is that approximately 25% of office-based physicians have a basic or fully-functional EHR. The percentage of those utilizing a system that is Meaningful Use capable is unknown. Other obstacles include the uncertain future of small practices. Why should a small practice at this time, operating on a marginal budget outlay a significant sum of money for an EHR if the very future of the practice (i.e. retire, merge, or become hospital-owned) is a common concern.
Hospitals, by all accounts and surveys, consider Meaningful Use adoption their biggest priority. EHR adoption by 50% of participating physicians in ACOs is a requirement. Meaningful Use incentives have already been paid out, but physicians are still wary of jumping on. It is estimated that only 40% of physicians have applied for Meaningful Use participation.
The requirements for stage 2 of Meaningful Use have been questioned and the implementation date for this phase is now uncertain (was to have been 2013). Objections by the AMA as well as almost 40 organizations representing specialists had objections to this phase’s mandates. Some of the requirements were not realistic when considering the specialists’ practices. The mandate for patient participation seemed onerous. Some mandates were not met by technological feasibility.
Although the subject of ACOs is not central to this issue, healthcare IT will be a critical part of how they operate, track patients, and are reimbursed. The success of the ACO landscape will hinge both on the success of Meaningful Use as well as the adoption of EHRs by physicians in the first place. This adoption then becomes paramount to the future blueprint of healthcare reform as is presently designed.
The choice of many vendors out there also makes it more difficult for adoption as physicians are wary of investing a significant amount of money into a system that is not best for their practice, that will not be around in a few years (the EHR market looks like the dot com market of a decade ago, and most players will not be around for the long haul), or will not be useful in event of practice sale to hospitals. Physicians testified to Congress already that their EHR companies were acquired by others and became useless.
EHR adoption at the physician level needs to be bolstered with better supports that guide physicians through the purchase process and Meaningful Use process.