Encouraged by the billions of dollars in government funding, technology companies are making a big push to help bring computerized health records into small-office physician practices.
This is crucial if the goal of bringing doctors’ offices into the computer age is to be achieved, with its promise of improving care and curbing costs. Three-fourths of all the nation’s physicians practice medicine in offices with 10 or fewer doctors.
But the challenge ahead is daunting, for reasons that have more to do with economics than technology. I have covered the efforts to digitize doctors’ offices for years now. From what I’ve seen, the success stories fit into two broad categories.
The first category of winners are the big, multispecialty physician groups that have the size, expertise and incentives to invest in electronic health records. The best ones use the technology to manage outcomes, i.e., make their patients healthier. They are often insurers themselves, so they capture the economic gains of better care directly, or use that improved performance to cut better deals with employer groups and insurance companies. These medical groups are examples of a better future for care, and and some of the showcase organizations include Kaiser Permanente, the Mayo Clinic, Geisinger Healthcare, Intermountain Healthcare and Marshfield Clinic.
The second cluster of success stories are in small practices. But they tend to be anecdotal and heroic. Typically, a lone physician or several of them in an office genuinely believe that they will be better doctors with modern computer technology. So they take the plunge, and invest the money in hardware and software. They train themselves, mostly. And they weather the inevitable headaches and lost time involved in putting a complex technology into effect.
These small practitioners can come out ahead financially because of the reduced paperwork and more automated billing. But it isn’t a money-making calculation. Nor are large numbers of physicians following their lead.
The technology doctors are investing in is called practice management software, and it’s used mainly for billing, not for electronic health records. More than 120,000 physicians use the practice management software supplied by General Electric, but only 35,000 use its electronic health records. At Athenahealth, which caters mostly to small practices, 20,000 physicians use its billing software, but only 1,100 have also opted for its electronic health records.
The Obama administration’s objective is to jump-start a market in electronic health records, with $19 billion in incentives for doctors, hospitals and regional health information networks. For physicians who demonstrate “meaningful use” of a “certified” electronic health record, the payments can be up to $44,000 a doctor. (The final definitions on “meaningful use” and “certified” record have not yet been determined, but those will include reporting quality measures and being able to share information with clinics, hospitals and government health agencies.)
The incentive payments are intended to reimburse doctors for much of their initial investment in digital health records. The companies pursuing sales to the small-practice market are betting that Internet-era computing will help them supply doctors with lower-cost, easier-to-use and less cumbersome technology. To efficiently reach clusters of small practices, the companies are partnering with hospitals, community and regional health agencies and other groups.
Dell is doing that in the Houston area with Memorial Hermann Healthcare, which has 13 hospitals and 1,850 closely affiliated doctors in small offices. The new Dell offering includes hardware, software and services, and the company is working with eClinicalWorks, a software supplier. The health records are mainly Web-based software, delivered over the Internet, from Memorial Hermann’s data centers. Dell will offer bridge financing for the physicians to ease the burden of the upfront expense of installing the technology.
For the last two years, Memorial Hermann has been engaged in a pilot project to help affiliated physicians install and use Web-based electronic health records. Until now, it has handled a lot of the assistance and technical support in doctors’ offices. It is pleased with the results, but so far it has only 163 physicians using the online records.
“It involves a lot of hard work in the doctor’s office,” said David Bradshaw, the chief information officer for Memorial Hermann.
The bundled Dell offering, Mr. Bradshaw said, promises to simplify and accelerate the adoption of digital health records by its affiliated physicians. “The big appeal to us is this will let us go faster because Dell is providing a turn-key solution in the doctors’ offices. We’ve been looking to do this for years.”
Dr. Douglas Fernandez, one of three physicians in a practice in the Houston suburb of Katy is in Memorial Hermann’s pilot program, begun two years ago. He estimates the initial cost of computers, printers, networking and installation at $30,000 a physician. The monthly software subscription and support expense is about $1,000 a month for the office, a gastroenterology practice. There are cost and time savings from the automated system, but Dr. Fernandez figures his office has spent more than it has saved on the new technology.
Still, Dr. Fernandez has no second thoughts about the move to electronic health records. He appreciates having all of a patient’s information — history, recent lab tests, medications — a mouse click away on the PC screen. The electronic health record also includes alerts of possible harmful drug interactions and suggestions of best-care guidelines. “It’s a significant step up in knowledge about a particular patient,” Dr. Fernandez said.
The offices are set up so the trim, flat-screen PCs are to the right of a doctor and patients sit to the left. “The computer never gets between me and a patient, ever,” he said.
At home, Dr. Fernandez can tap into the system at any time. When he is on call and a partner’s patient calls him at 2 a.m. with an abdominal pain, Dr. Fernandez explained, he can view that patient’s medical record from his PC over the Internet and make an informed diagnosis quickly. He can even electronically prescribe a needed medication.
“It makes my life better,” Dr. Fernandez concluded.By Steve Lohr
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