Despite the high cost of clinical information systems and the oft-referenced dearth of technical savvy and support services for the technology in smaller physician offices, more than 15,000 solo and smaller group practices have installed some form of electronic health record system, according to a recent survey of vendors by an arm of the American Academy of Family Physicians.
Thirty-six healthcare technology vendors participating in the academy's Partners for Patients initiative, which aims to boost IT use among member physicians, were surveyed by the AAFP's Center for Health Information Technology. They reported the number of EHR installations -- both stand-alone EHRs and EHRs integrated into a suite with that company's own practice management system -- they had operating in physician offices.
According to the survey, smaller practices had the largest number of installed and running EHRs systems, particularly stand-alone EHR systems, while larger groups favored the combined EHR/PMS systems.
The academy grouped the data by practice size. In practices with four or fewer physicians, vendors reported 8,775 practices had live EHR systems installed and 6,414 had EHR/PMS suites. Vendors said that 1,255 medium-sized practices (five to 10 physicians) had stand-alone EHRs installed, while 1,816 had the combination EHR/PMS systems. Among the larger physician groups (more than 10 physicians), 1,131 had integrated EHR/PMS systems, compared with 884 that had stand-alone EHRs.
Participating companies reported that, combined, 85,094 physicians have purchased their systems, or about 12% of the American Medical Association's estimated 690,000 physicians in active medical practice in the U.S.
The Commonwealth Fund in December released a report based on a survey of 1,837 physicians that found physicians in groups of 50 or more were 7.7 times more likely to have access to an EHR than docs in solo practice. Data from Modern Physician's annual survey of technology use released in January also indicated the existence of a digital divide between small and large group practices.
EHR system pricing, the survey report said, is difficult to quantify and compare, given vendors' various pricing schemes and whether hardware and software upgrade costs are factored into their final prices.
Surveyors asked the vendors to give a retail price for their best systems, which the academy averaged over a three-year period, a time frame the AAFP said was chosen due to a "low likelihood of new hardware needs during that time."
The average total cost per physician for a typical three-physician group practice was $7,232 a year for an integrated EHR/PMS system, according to the report, and $5,537 a year for a stand-alone EHR system.
"These costs still represent a significant purchase for primary-care doctors but (they) are approaching affordability for a larger segment of the small-practice population," according to the report.
That said, the report disclosed an enormous range in price, from $3,000 to $134,750 for an integrated EHR/PMS system and from $3,000 to $128,000 for a stand-alone EHR. Annual maintenance fees also ranged widely, from 10% to 20% of the initial application costs, with the average fee at 11.7%.