While overall adoption of robust healthcare information systems remains low, a chasm is opening between large and small physician office practices in their use of IT as financing costly electronic medical records systems remains the most commonly cited barrier to adoption, according to a national survey of 1,837 randomly sampled physicians.
Virtually every survey of healthcare providers reports the high cost of EMRs and related healthcare IT systems as the number one impediment to their purchase and use, including every annual Modern Physician IT survey going back to 1998.
So money as a major impediment to IT came as no surprise in the latest survey conducted by the New York-based Commonwealth Fund, according to Anne-Marie Audet, M.D., its vice-president for quality improvement and lead researcher on the project. The not-for-profit healthcare think tank conducted its survey by mail and on the Internet between March and May 2003 and found 56% of those responding cited startup costs as the most formidable obstacle to IT use, followed by lack of uniform standards (44%) and lack of time (39%).
The use of various parts of an electronic healthcare record and communication system varied widely.
While 79% of physicians surveyed reportedly use an electronic billing system, only 28% used a system to e-mail other physicians, 27% used an electronic system to prescribe drugs or order tests, 24% had a system with clinical decision-support tools, 18% used a system to exchange e-mail with patients, and just 12% had a system that issued electronic drug-prescribing alerts.
Because healthcare IT systems have many functional parts, the surveyors created a variable that describes a "high-tech office" comprising at least four of nine electronic tools or functions: an EMR, ordering of drugs and tests, access to test results, decision support, e-mail to patients, e-mail to physicians, electronic reminders, drug alerts and prompts when follow-up care is needed.
"The odds of a physician practicing in a high-tech environment are 7.7 times higher for physicians in large practices than if they are in a solo practice," said Audet.
For EMRs alone, nearly 60% percent of physicians in groups of 50 physicians or more used an EMR routinely or occasionally, compared with physicians in solo practice, where 25% reported similar levels of EMR usage, according to the survey.
Audet said this technology gap between solo and small-group practices and large groups presents a challenge to healthcare policymakers such as David Brailer, M.D., the national coordinator for health information technology at HHS.
"Those at the larger groups are well supported," Audet said. "We have to think about the fact that over three-quarters of the office physicians are in the small-practice setting. So, whatever policies we develop have to address these small groups, or in six or eight years we'll be in the same place we are now."
All physicians in the survey were drawn from a sample taken from the American Medical Association's physician master file, and all were involved in direct care of adults and had been in practice for at least three years after completing their residency training. The survey excluded radiologists, pathologists, anesthesiologists and dermatologists.
Brailer, at a press briefing last week in Chicago, said his office is spending the bulk of its time preparing recommendations for President Bush for the 2005 budget, an outline of which will be delivered in January at the annual State of the Union address.
Two important issues for physicians in medical groups are Stark limits on hospital assistance to extend information technology to affiliated physicians and taxes on retained earnings in partnerships, which penalize many groups if they accumulate capital for IT systems.
Without being specific, Brailer said the government is subjecting various proposals to boost IT adoption to a "rigorous analysis" of their potential benefits as well as their implications on antitrust and taxation, but office-based physicians are at the focus of these efforts.
"Stay tuned," he said.
