The idea that docs are technophobic is pure nonsense," says Bill Crounse, M.D., global industry manager for healthcare at Redmond, Wash., software powerhouse Microsoft Corp. "If (technology) serves a particular business purpose, they will adopt it."
The results of the 2003 Modern Physician/PricewaterhouseCoopers information technology survey largely support Crounse's opinion. For the second year in a row, physician leaders say their hospitals and fellow doctors are joining the information revolution as both physician acceptance of automation and organizational investment in technology rise.
"We're certainly headed for more and more electronic record keeping," says survey participant Ray Mummery, M.D., CMO of Dimension Health, a Miami-based PPO with 400,000 enrollees in South Florida.
Slightly more than 80% of those surveyed say physicians in their organizations rely on computers for billing and claims submission, about the same as a year ago. Scheduling remains the second most popular application, nearly unchanged at 74.3%.
But solid majorities now manage laboratory orders and results (63.3%), communicate with hospitals (57.1%) and check claims status (52.5%) with the help of computers. Growth in electronic medical records adoption is particularly dramatic, as computer usage for patient records has grown to 50.5% of survey respondents from 38.5% in 2002 (see related story, page 18).
The 2003 survey also indicates gains of at least 5 percentage points in physician use of computers for diagnostic imaging and patient referrals.
Survey results "certainly parallel our experiences with physicians over the past year," says PricewaterhouseCoopers healthcare expert Donald Michaels, who helped analyze the data. "We have noticed a definite trend among our physician clients to more fully embrace technology."
Aurora Health Care, a 13-hospital not-for-profit health system based in Milwaukee, employs 750 physicians and counts another 1,700 doctors with staff privileges.
"About half of our (employed) doctors are doing everything electronic," says Michael Gorczynski, D.O., director of medical informatics. "By the end of December, every single one of our doctors will be writing prescriptions electronically."
Just as in the 2002 survey, the top motivation for IT investment is the opportunity to improve business performance, physician executives say. Clinical quality improvement and management of practice growth again hold the second and third spots.
However, clinical integration of multiple locations has shot up to fourth place on the priority list from seventh in 2002.
"Up until the present time, the primary stumbling block has been getting all the systems to talk to each other," Mummery says.
More money is going to information technology than in past years, as 36.3% of those surveyed say their organizations devote at least 4% of total operating expenses to IT. Last year, just 27.1% of physician executives surveyed said they were budgeting at 4%. The share of organizations spending less than 2% on IT has fallen markedly in the past year to 21.2% from 32.6%.
In anticipation of higher investment, the "less than 1%" category was eliminated from the 2003 survey form in favor of "5% or more." One-fifth of 2003 respondents allocate at least 5% of expenditures for IT.
In the family practice clinic at Memorial Hospital in South Bend, Ind., IT spending is now below 2% of the budget, but that is about to increase. At press time, the clinic was making its choice of a full-powered EMR after four years with a rudimentary system that required the clinic to keep both paper and electronic charts, says Kenneth Elek, M.D., director of the outpatient clinic.
"We will get rid of transcription, and we will probably get rid of one of our medical records people right off the bat," says Elek, who supervises 25 to 26 residents in family medicine and one to two OB/GYN fellows.
The Memorial Hospital clinic has been preparing for the transition to a paperless environment for several years by requiring all residents to complete a course on computers in medicine before Nov. 1 of the first academic year of their residencies.
"It's important for our residents to know the latest technology before they complete their training here," Elek says.
The University of Illinois Medical Center at Chicago is among those institutions that allocate at least 5% of their budgets to IT. Even though it long ago went 100% paperless with outpatient medical records and has achieved 100% computerized physician order entry on the inpatient side, the academic hospital is a long way from full clinical automation.
"I think we would have to spend more to move faster," says the Chicago hospital's neurology and rehabilitation chief, Daniel Hier, M.D. Hier serves as physician adviser to the IT services department. "The limiting factor right now is money. We have the will, we have the culture."
In July, the National Library of Medicine agreed to pay the Northfield, Ill.-based American College of Pathologists $32.4 million over five years to make the Snomed CT standardized terminology set available free nationwide, removing a major barrier to widespread sharing of clinical information.
On July 1, HHS Secretary Tommy Thompson asked Ann Arbor, Mich.-based standards-setting organization Health Level Seven and the Institute of Medicine to develop a voluntary standard for electronic health records and report back within two months. Although HL7 membership voted down an initial proposal in September, the plan is being refined in anticipation of another vote in January.
Click here for a PDF file of the chart "What do your physicians use computer-based systems for?"