Electronic medical records, a $526 million industry last year, is expected to grow by 8% annually, approaching $750 million by 2004, according to a recent market analysis by San Jose, Calif., consulting firm Frost & Sullivan.
The technology survey suggests those numbers are reasonable. Some 27.3% of respondents to the 2001 survey say their physicians already use computer-based systems for patient records, up from 21% a year ago.
Another 44.7% expect to have EMR systems within three years, which would bring total EMR usage to 72% by 2004. In the 2000 survey, 63.3% said they anticipated having computer-based medical records within three years.
Whether those forecasts ring true will depend heavily on cost factors, logistics of integrating the many components and protocols of EMR systems and physicians' willingness to change entrenched methods of record keeping. At present, EMR adoption remains slow, especially at smaller medical practices.
David Patterson, M.D., a Fishers, Ind., allergist, spends more than 4% of his total budget on information technology. He writes electronic prescriptions on a handheld personal digital assistant, transfers data electronically to and from a local hospital, surfs the Internet often and uses computers for billing and claims submission. But the solo practitioner has not invested in an EMR.
"We've been looking for an EMR for a year, but we haven't found one we like yet," Patterson says. He has been unable to find a complete, affordable package that is suitable for a specialist in solo practice.
Until the crowded marketplace consolidates further, Patterson would have to install multiple servers and sign multiple maintenance agreements in order to piece together a system, a costly and unwieldy proposition. "All these software packages should be connected--EMR, practice management software, billing, script writing," Patterson says.
Connectivity remains a hurdle to wider EMR adoption. "Transferable records will be a mainstay within a decade," says Amith Viswanathan of Frost & Sullivan's Healthcare Practice Group. But, he acknowledges, "Transferability--the ability to move records from department to department or to and from a central repository--has been a hindrance."
John Hennessy, executive director of Kansas City (Mo.) Oncology and Hematology Group, a 23-physician group affiliated with US Oncology, does not foresee the practice investing in a full-blown EMR system anytime soon. "There really is no integration," he says.
Hennessy is investigating some EMR components but says it's essentially a matter of trial and error to find pieces that not only serve a useful function for the medical group but are also compatible with each other.
So far he has been unsuccessful in his quest to find a way to post dictations and transcriptions on the Internet so physicians at multiple locations can call up the information.
Like Patterson, Keith McReynolds, M.D., a Mesa, Ariz., otolaryngologist, will not be ready for an EMR until the ranks of vendors thin out considerably. "We're waiting for it to shake out so there are some more standardized systems," McReynolds says. He estimates it would cost his four-physician practice $20,000 just to upgrade his computer systems for HIPAA regulations without adding EMR capability. He has no reliable estimate of the cost of a suitable EMR.
Even the larger medical groups are clamoring for some standardization. The western region of Team Health, a hospital-based PPM based in Knoxville, Tenn., puts most of its IT budget into back-office functions like human resources and accounting, according to regional chief information manager Philip Chase, M.D.
"We've been trying to keep our powder dry on the EMR side because there are so many vendors out there," he says.
Cynthia Sherry, M.D., a Dallas radiologist and chair of the physician leadership council at 13-hospital Texas Health Services, says her 14-physician radiology practice is not even looking at an EMR until the technology evolves some more.
In mentioning a limited test of paperless and filmless systems at one of THS' smallest and newest hospitals, Sherry says, "Going filmless is really easy, but going paperless is very hard."
The radiology practice is studying computerized physician order entry, but there are no plans to implement it on a permanent basis. "I'm counting on sort of a maverick group of docs that may make a physician-driven effort to do this," Sherry says.
Solo family practitioner Werner Leibold, M.D., of Canyonville, Ore., has been making his own effort. He has an EMR in place and also uses electronic systems for claims submissions, some prescription writing, supply procurement, scheduling and charge-capture functions.
But Leibold has been practicing medicine for 30 years. While his son, an electronics professional, has been working to digitize older records, Leibold's EMR system currently only goes back about five years. "Catching up on all the back records is preventing me from going to a full EMR," he says.