Success of a national health information infrastructure depends on the widespread use and acceptance of electronic medical records in doctors' offices, according to a new federal legislative proposal released today by the American College of Physicians that seeks to speed IT deployment in small group practices.
The nation's largest subspecialty society said the biggest barriers to IT adoption in these groups are high acquisition costs of the systems, which are upwards of $30,000 per doctor, physician and staff time required to transition from paper-based record keeping systems and lack of industry standards for interoperability of various systems on the market.
The ACP, accordingly, focuses on easing the cost burden on office-based physicians and setting standards to make the systems work together. The ACP estimates one half of all practicing physicians in the U.S. work in offices of six physicians or less.
"Tax credits, grant programs, loan programs and reimbursement incentives would make it possible for physicians in small practices to invest in the technology," said ACP President Charles Francis, M.D., in a prepared statement.
"Before America's patients can truly reap the benefits of health information technology it must be available and working where most people receive care."
The proposal comes two days before David Brailer, M.D., the national coordinator for health information technology, releases his update on a national IT strategy. The ACP calls on the Secretary of Health and Human Services, through Brailer's office, to adopt the standards referenced in its proposal. Brailer has said repeatedly in speeches since his appointment to office in May that bringing IT to physician offices is a baseline goal.
Standards for system interoperability are to be developed by standards-setting organizations accredited by the American National Standards Institute and adopted only after consultation with various healthcare groups, including national physician organizations, hospitals, patients and government healthcare agencies with the Department of Veterans Affairs and the Department of Defense, according to the ACP.
The secretary also should rely on recommendations for standards by the National Committee on Vital and Health Statistics. The 18-member NCVHS advises HHS on healthcare IT and is currently working on electronic prescription-writing standards.
Trial standards under the proposed legislation must be adopted within two years of enactment followed by a two-year trial period to test their efficacy.
In addition, the proposed legislation calls for HHS to use "any, all, or a combination of financial incentives thereof to assure small health care providers . . . to move toward a national health care information infrastructure by acquiring electronic medical record systems . . . that meet the standards adopted or modified under this Act."
The financial incentives shall include government grants, tax credits, additional Medicare payments and loan guarantees. In addition, payment methods could include changes in the sustainable growth rate formula for physician services, care management fees for users of IT to manage chronically ill patients and payments for e-mail consults.
The payments and incentives, while not specified in dollars, shall be determined by HHS and take into account "the costs of implementation, training and complying with standards" outlined in the legislation.
The act shall be exempt from existing legislative requirements for budget neutrality.
An ACP spokesperson said no legislator yet has agreed to carry the bill, but interest should peak following Brailer's announcement of an IT plan Wednesday.
"We're shopping it around on the Hill," said Bob Doherty, senior vice president of governmental affairs and public policy for the ACP. "I think there is a great deal of interest in trying to identify incentives to target physicians in small practices."
As for Brailer, "I think philosophically he's made it very clear that the individual physician office, the physician in the small office, where most care is still delivered in this country, is really the linchpin. In order to move this along, there have to be economic models for small practices. They need the upfront costs to acquire systems, but there also need to be changes in the reimbursement system to support care in an environment that supports information technology. For example, right now, Medicare won't pay for e-mail visits."
"We understand the government isn't going to write blank checks to buy systems," Doherty said.
He said the proposal would link acceptance of financial help to voluntary participation by physicians in studies or other quality improvement efforts.
"We understand that if the government wants to invest in this, they would ask that they get some data out of it to make sure that it's working," he said.