A growing divide in healthcare IT

Small practices slow to adopt electronic medical records because of cost

Electronic medical records and other IT upgrades are seen as a “silver bullet” in the health industry’s struggle against rising costs and quality problems, but high startup expenses are creating a growing divide between big industry players and small practices, said the keynote speaker of a healthcare IT conference hosted by the Massachusetts Health Data Consortium last week.

Fewer than one in four doctors nationwide have begun using electronic health records (EHR), and most who are using electronic records have done only a partial implementation, said John Glaser, vice president and CIO of the Massachusetts hospital chain Partners HealthCare System.

Meanwhile, the Mayo Clinic is taking a lead role in electronic medical records and large corporations such as Wal-Mart are providing their employees with personal health records (PHR), which let patients log onto the Web and view medical information such as test results and instructions for taking medication. Promoters of personal health records say they let patients make better decisions related to their care, but people who go to small medical practices may be left out.

Doctors slow to adopt electronic health records

“We’ve got a divide now and it’s going to get worse in the years ahead,” Glaser said.

Many people believe that IT is the answer to problems ailing the health industry, and Glaser counts himself among them. But he said people have unrealistic expectations for IT because all previous approaches to containing cost and maintaining quality have failed.

“We ought to be real about this,” he said. The transition “will not be orderly. It will be chaotic.”

The U.S. government has made the promotion of electronic medical records and personal health records an official goal. On its Web site, the U.S. Department of Health and Human Services says that because deploying electronic records is costly for smaller practices, the expense must be shared by clinicians and others in the healthcare system.

Access to electronic medical records must be increased in rural and underserved areas, in particular, government health officials say. Regional collaboration among healthcare entities in the form of regional health information organizations can help make patient information easily transferable from one physician to another, they say.

Already, a private sector certification commission has been formed to certify software used to digitize medical records, but a large majority of clinicians still use paper records only.

“Those who are using EHRs are considered pioneers among their peers,” states the federal Office of the National Coordinator for Health Information Technology on its Web site. “An increasing number of studies have found that EHRs can result in positive patient-care outcomes, but many physicians remain reluctant to embrace them. Accelerating the use of EHRs among clinicians requires that they are better informed about the benefits of incorporating greater technology into their practice and how it can benefit their patients.”

The conference where Glaser spoke, held last week in Burlington, Mass., was titled “Integrating Electronic Health Records (EHR), Personal Health Records (PHR) and e-Prescribing.”

Janie Tremlett, senior strategic adviser for Concordant, a provider of IT infrastructure services in the healthcare field, said the various sectors of the healthcare industry should join together and figure out how to devise a sustainable funding model and handle ongoing costs. Even malpractice insurers should be involved, she said.

“How do we begin to get our heads around this cost?” Tremlett said. “I’ve heard unbelievable numbers, from $10,000 a practice to $100,000. That’s a big range.”

The medical field also has to decide whether databases holding medical records will be centralized or decentralized, and make a governance plan outlining who is responsible for each portion of the movement toward electronic records.

On the e-Prescribing front, the pharmacy industry in 2001 formed a group called SureScripts, which now provides electronic prescribing services to more than 100,000 doctors in 46 states.

E-Prescribing is the completely electronic transmission of prescription information from the prescriber to a pharmacist, and can reduce medication errors, said Kate Berry, senior vice president of SureScripts.

Americans receive more than 3 billion prescriptions each year, and pharmacists have to call physicians 150 million times a year because of indecipherable or unclear prescriptions, she said. More than 1.5 million Americans are injured each year by medication errors, she said.

“It’s widely known that legibility is a great challenge and potential safety issue,” Berry said.

E-Prescribing can save time for both doctors and pharmacists while providing cost savings to insurance plans that are realized because of greater formulary compliance, she said.

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