Jeffrey Glassheim, D.O., a Fresno, Calif., allergist, contracted with an application service provider to handle his practice management in late 1998 after going through three billing services in his first 10 months of solo practice.
Glassheim since has added ASP service for charge-capture functions and for Web site development, though he has no immediate plans to upgrade to a full electronic medical records system. "I'm sort of middle-of-the-road with that," somewhere between full EMR functionality and keeping a handwritten ledger for patient records, he says.
It's a position that reflects the current mood of physician leaders regarding online information management.
On the surface, an ASP appears to be a good, low-cost alternative to the purchase of massive, inhouse data processing and storage systems for practices looking to automate. But, like many emerging technologies, the ASP model has been slow to catch on with physician executives.
Although slightly more than half of those responding to the technology survey say they are using or considering the use of ASPs, most are doing little more than considering.
Nearly 45% of the respondents are examining the possibility of contracting with an ASP for the creation and maintenance of electronic medical records; a similar number is looking at ASP-based prescription writing. Yet fewer than 8% actually have ASPs for patient records, and just 8.6% currently write electronic scripts through a third-party vendor.
About one of every eight physician executives surveyed is unfamiliar with ASP technology. Those who do understand the concept raise questions about the reliability of such Internet-based services, the viability of service providers and whether they might lose some control over their practices.
Arnold Weil, M.D., principal of a three-physician nonsurgical orthopedic practice in Marietta, Ga., is among those who are considering ASPs for EMR, practice management and script writing. "We're trying to go to a paperless office," he says.
So far, the practice has not achieved that goal. "We looked at an Internet-based EMR system, but it didn't do what we wanted it to," Weil explains. "I have a lot of concerns about the reliability of those systems."
Ear, nose and throat surgeon Keith McReynolds, M.D., of Mesa, Ariz., has been investigating an ASP-based prescription writing system that would run on his personal digital assistant. He and his three physician partners also may consider an ASP for supply purchasing--but not until they are more confident of the Internet link between practice and service provider.
"Although it would save us upfront capital, we're not sure it's better. Being unsophisticated (about technology), the Internet security thing worries me," McReynolds says.
As regional chief information manager for hospital-based PPM Team Health in Pleasanton, Calif., Philip Chase, M.D., is plenty sophisticated when it comes to IT, yet he, too, has some reservations about the security and privacy of information sent over the Internet.
But he says ASPs help solve a common problem with clinical data management: connectivity. "It's a good peer-to-peer technology," Chase says, especially for the many Team Health emergency and urgent care physicians who have to treat patients whose medical records are off-site.
"They have advantages if you get the kinks out and get the proper support," Chase says of ASPs.
A key benefit of ASPs--remote storage and backup of data--became evident in the days following Sept. 11. Says Chase, "The recent terrorist attacks have emphasized the problem you have when you have a single repository of patient records. I think the Internet holds a lot of promise in that area."
And because ASPs are Internet-based, they help reduce staff training time. "If you have a Web browser, you can use an ASP," says Patrick Zook, M.D., a family doctor at St. Cloud (Minn.) Medical Group, a 42-physician multispecialty group practice.
But like EMRs, some ASP components are more utilitarian than others. "We've tried some of that voice recognition stuff, but I talk so fast it didn't work very well," says urologist Tom Alderson, M.D., a partner in a four-physician specialty practice in Lafayette, La.
Lately, Alderson has been testing electronic charts and charge-capture functions and also has looked at ASPs for prescription writing and transmitting patient data to hospitals. "Just to be ahead of the curve, I'd like to be able to do some of that," he says.
Alderson likes what he has seen because he believes e-prescribing must be integrated into other systems, and he says ASPs can help practices overcome some of the connectivity issues that have hindered the move to full EMR systems.
"We want to be able to interface with different kinds of platforms that different kinds of vendors offer," he says. "An ASP is kind of an interim step to that."