In recent years, growing competition from physician owners of ambulatory surgery centers and surgical hospitals has irked more than a few acute-care hospital physician executives and lay administrators.
Physician frustrations with hospital operations, exacerbated by recent rounds of hospital retaliations in the form of economic credentialing and legal actions against fellow doctors, have set many physician group leaders on edge. Leaders of goodwill on both sides of the hospital-physician divide often talk about improving relationships and aligning interests between the two camps. But how?
Physicians and hospitals are under tremendous pressure to improve and connect their clinical and business-side information technologies, and that's one huge opportunity for cooperation and mutual gain, according to a recent survey on clinical IT and connectivity between hospitals and physician group practices.
Modern Physician and the Kennedy Group, a healthcare IT consultancy based in Chicago, found through the survey that hospitals have a largely untapped yet willing market for providing IT support to physician groups.
Underscoring the shaky relationships between physician practices and hospitals, the survey showed about 26% of groups turn to internal staff to run their information infrastructure.
On the other hand, an equal percentage is already looking to their hospitals for IT support.
What is promising for hospital-physician peacemakers is that 44% of the respondents in the 1,008 medical group practices who took the survey last fall indicated they have no qualms about accepting technology services from affiliated hospitals.
In contrast, just one in seven medical group leaders surveyed had issues with trusting hospitals with their data.
Far more often than trust, group leaders cited concerns about what hospitals might charge for data services, possible incompatibilities in IT systems or level of service.
"I think a lot of this is miscommunication between hospitals and physician groups," said Janet Kennedy, executive director of the Kennedy Group.
Kennedy said her firm found a similar misunderstanding between practitioners and technologists in earlier research on computerized physician order entry, or CPOE. "(In) the survey we did on CPOE, the (chief information officers) felt like they were giving a lot, but (they said) physicians seemed like an ungrateful lot," she said.
Higher clinician acceptance found
However, the new survey suggests that physician attitudes toward technology are changing.
Only 23.3% of respondents consider clinician acceptance of technology to be a large barrier to IT implementation, far below the perceived hindrance levels of cost, product usability and lack of qualified technology staff, according to the survey. More than 11% say physician reluctance is not a barrier at all.
"I think it's less of an issue with each passing day," said Catherine Sprague, a Kennedy Group senior associate.
Anecdotal evidence supports this opinion. Foote Hospital in Jackson, Mich., is in the process of hiring someone for the newly created job of director of physician integration, a person who will forge electronic links between the hospital and its affiliated practices, according to Vice President of Medical Affairs Mark Browne, M.D.
Foote Hospital currently provides IT services to four primary-care practices "on the periphery of our service area," Browne said.
These physicians, whom Foote employs directly, are networked into the hospital infrastructure, which includes a picture archiving and communication system from GE Medical Systems and billing software from IDX Systems Corp. The IDX system is ready to interface with a TouchWorks EMR from Allscripts Healthcare Solutions, but the hospital has not implemented the records system just yet, Browne said.
Foote Hospital also owns a medical office building and rents out suites to independent physicians. The building has hard-wired links to the data infrastructure at the hospital, but Browne said Foote Hospital has not aggressively marketed that connectivity to physicians--yet.
"We are investigating the opportunity of developing a wireless network" to allow staff physicians to access the system remotely, Browne said. "We're looking at developing a whole suite of services for ambulatory docs. We haven't fully developed it yet, but we do want to offer these value-added services to our staff."
Browne, a pediatrician who no longer practices, said this could include the leasing of electronic medical records access once a system is functional.
"Foote Health System is fortunate in that the hospital board, administration and medical staff leadership are all on the same page with regard to understanding the importance (information technology) development will have upon the future of our healthcare system," said Jonathan Sykes, M.D., Foote's medical director of informatics, in a written statement to Modern Physician.
If the Kennedy Group survey results are any indication, demand could be strong, as physician reluctance to spend money on technology apparently is fading. More than 26% of respondents said they consider it acceptable for medical practices to allot a minimum of 5% of total operating expenses to IT, though at least as many are unsure of what the appropriate spending level might be.
Upward of 80% of healthcare-provider organizations consider electronic connectivity with payers to be "critical" or "very important" to their practices, and 76% say the same about connectivity with clinical partners, according to the survey. Clinical systems such as CPOE, electronic medical records, or EMR, and results reporting ranked third, deemed highly significant reasons for investing in IT by nearly two-thirds of the survey pool.
Group size matters
Still, it is hard to draw blanket conclusions about the findings, as answers tend to vary widely depending on practice size, ownership and specialty. Generally, the larger the group, the higher the EMR penetration level, with the exception of groups of 16 to 20 physicians, which have a 35.3% usage rate.
Hospital-owned groups have higher levels of EMR penetration, at about 22%, compared with physician-owned groups, which average slightly more than 15%.
"Overall, the larger the group, the more critical all these components are," the survey says, though Kennedy Group researchers note that emphasis on physician-patient connectivity "remains disturbingly low," regardless of practice size.
Larger groups are more likely to have EMRs in place or under development. Of the entire survey pool, 17.8% currently have working EMRs and another 9.3% are in the process of implementing EMR systems. But 60% of practices with more than 200 physicians fall into one of these two categories.
Also far ahead of the average, radiologists surpass the 60% mark for EMRs in use or in progress, according to the survey. Close to 20% of family practices queried have completed EMR implementation in one form or another, though groups focusing on internal medicine have only a 13.1% EMR usage rate.
Pediatricians and surgeons also lag behind other specialties, the survey indicates.
In explaining the disparity in the results between primary care and radiology, Kennedy says, "You're not as technology-driven from the get-go" in primary care. "In the pediatric world, they don't see IT as improving the quality of care. A lot of specialties are like that."
Kennedy adds that radiologists were among the first to be exposed to technology in clinical settings, with advanced imaging machines and, more recently, picture archiving and communication systems, or PACS.
"We had a PACS way before the hospitals," says Stephen Miley, M.D., managing director of Axcess Diagnostics, a nine-physician imaging center and practice in Venice, Fla. He says that advanced magnetic resonance imaging and computer tomography procedures can generate up to 1,000 images per scan with a digital system, something that would be virtually impossible--and prohibitively expensive--with film.
"More and more people are going to be capturing images digitally rather than on film," Miley says.
Although Axcess Diagnostics does not currently have an EMR, the practice can send images as GIF picture files and reports as Word documents to referring physicians via e-mail, according to Miley.
"By going digital, it saves money and saves a lot of staff time," Miley says.
In contrast, surgeons are less likely to embrace IT because much of what they do requires their full concentration on the patient at all times, and a lot of their documentation is verbal while they are operating, Kennedy says.
And yet, of all specialists surveyed, surgeons place a high value on IT components, second only to radiologists. Kennedy attributes this in part to the impact of managed care on surgical practices.
"They are the ones who get discounted the most and argue the most (with payers)," Kennedy says. "They are the ones who get the most bounce-backs in terms of coding."
Neil Versel, a former Modern Physician reporter, is a freelance healthcare writer based in Chicago. He can be reached at [email protected]