Hefty upfront costs, which have been a barrier to widespread adoption of electronic medical records, particularly at the smaller group practice level, could be reduced under an alliance launched Nov. 12 between the American Academy of Family Physicians and nine health information technology companies.
Another deal to hasten EMR adoption is in the offing, as the Healthcare Information and Management Systems Society is negotiating with the AMA to provide discount access to an ambulatory EMR selection tool, according to Bethesda, Md., informatics consultant Carolyn Samuels, M.D. Samuels created the utility for the online HIMSS Solutions Toolkit to help medical practices find the EMR product that best meets their needs.
To family physicians, 70% of whom work in groups of five doctors or less, affordability has been the biggest roadblock to implementing EMR systems, says AAFP President Michael Fleming, M.D.
"It is absolutely critical that we make this available to every physician no matter the size of the group or the size of the community," Fleming says.
The partnering companies will provide discounts on technology resources, such as hardware, software and digitally prepared medical devices. Five EMR vendors also will offer month-to-month financing to help family practices afford what typically have been $25,000 to $50,000 in upfront implementation costs.
David Kibbe, M.D., director of the AAFP Center for Health Information Technology, says about 95% of the academy's 60,000 practicing members have computerized practice management systems, but fewer than 10% use a commercial EMR. In 1999, AAFP set a goal to have half its members using electronic charts by 2005.
"We hope we've arranged the great American electronic health system sale of 2004 and that our members will take advantage of this to turn their intellectual decisions into economic ones," Kibbe says.
He says AAFP has shelved plans to establish a new foundation that would distribute an open-source EMR product, provided by MedPlexus of Santa Clara, Calif., because it couldn't attract enough medical society partners.
An open-source pilot project, however, is still going forward.
"Some people continue to believe that (existing EMRs) may one day be licensed as open-source applications, and we would support those efforts if our members wanted us to," Kibbe says, adding that the most likely prospect on that front may be the public-domain clinical records system of the Department of Veterans Affairs.
The VA also is leading public-private discussions with the AAFP and others of a long-term vision for what is being called a "virtual health system" of interoperable electronic medical records and personal health records, a top government informaticist says.
Gary Christopherson, a senior advisor at the VA, says about 30 major healthcare organizations, technology vendors and government agencies met Nov. 3 to discuss how they could work together on the strategy, unofficially referred to as HealthePeople. It is an outgrowth of the Consolidated Health Informatics strategy to link the VA, Military Health System and Indian Health Service of HHS with standardized communication and data protocols.
Among the participants were Kaiser Permanente, CMS, the American College of Physicians, the Connecting for Health project of the Markle Foundation, Hewlett-Packard Co., Microsoft Corp., Epic Systems Corp., HIMSS and the Institute of Medicine, according to Christopherson.
Christopherson says the VA is encouraging other entities to participate. "The collaboration is a wide-open collaboration," he says.
The AAFP partnership with vendors is a continuation of the academy's resolve to see a breakthrough in adoption of EMR among members, Kibbe says. It is guided by four principles: affordability, compatibility, interoperability and data stewardship.
"We'll continue to work with these vendors, and others who join the coalition, on standards and activities that put these principles into practice," he says.
Mark Leavitt, M.D., vice president of clinical initiatives for GE Medical Systems Information Technologies, says family practices that have successfully adopted EMR systems have experienced 15% efficiency gains.
The benefits of EMR increase exponentially as the number of users increases, says John Dulcey, M.D., CMO of NextGen Healthcare Information Systems. A rising tide lifts all boats, he says, including those of the vendors.
"The biggest thing to us is getting a greater presence in the marketplace and having as many installations as possible, because small practices become big practices," Dulcey says. "We see this as a benefit for everybody."
AAFP alliesCompanies that have joined the alliance
- A4 Health Systems
- GE Medical Systems Information Technologies
- Hewlett-Packard Co.
- NextGen Healthcare Information Systems
- Physicians Micro Systems
- Siemens Medical Solutions Health Services Corp.
- Welch Allyn