Despite industry hype and government promotion of electronic medical record systems, survey results published last week indicate physicians have been slow to jump on the information technology bandwagon. And experts say financial assistance, technical support and a better alignment of interests between payers and providers are needed to get the IT adoption "needle" to jump forward.
Researchers from the Medical Group Management Association in Englewood, Colo., surveyed more than 3,000 groups in the MGMA national database during January and February, and found there was only a 12.5% adoption rate in medical groups with five or fewer full-time physicians.
The adoption rate, however, increases significantly with the size of the practice. For groups with six to 10 full-time physicians, the implementation rate was 15.2%; for groups with 11 to 20 full-time physicians, it was 18.9%; and for groups with 21 or more physicians, it was 19.5%.
File cabinet vendors had reason to cheer, as 78% of practices with five or fewer full-time physicians were still using paper medical records, as were 65.8% of the practices with 21 or more full-time physicians.
Cost remains a significant barrier to EMR use and varies according to group size, the study found. The average cost of purchasing and implementing an EMR system was calculated to be about $32,600 per full-time physician plus an additional $1,500 a month per physician for maintenance. But for small practices, the initial cost was about $37,200 per physician.
"It makes you sit up and take notice that there is a clear benefit for larger groups to have these systems in place," said Jon White, a health IT portfolio manager at the Agency for Healthcare Research and Quality, which financed the study. "The small groups haven't recognized that or it hasn't translated to them. This reflects that we're not seeing the surge in adoption that was predicted several years ago."
MGMA President and Chief Executive Officer William Jessee agreed. "The needle hasn't moved very much," he said. "With all the hype that is going on, people haven't been going out and buying these things like crazy. They're being cautious."
Jessee says that more research should be done to analyze the practices where IT is working well and the benefit of its use is being seen. "What did they do to make it turn out right?" he said. "We have to learn that and let people know about it."
Patricia Wise, vice president of the Electronic Health Record Initiative for the Healthcare Information and Management Systems Society, noted that money remains a key issue, but said her own research has found the cost of implementation to range between $20,000 and $33,000. Wise also said she was encouraged by the finding that 12.7% of the groups surveyed were already implementing an EMR system, 14.2% said implementation is planned for the next year, and 19.8% said implementation was planned in 13 to 24 months.
"I think everybody would wish that the numbers were higher and more practices are fully implemented, but it is encouraging to know that more are considering it," Wise said.
Dan Michelson, chief marketing officer for Allscripts, a Chicago-based healthcare IT vendor, also said that the report had encouraging findings. Chief among these were that 28.5% of the practices with 21 or more doctors were already implementing an EMR system and that 20% of the groups with 11 to 20 physicians planned to implement a system within 12 months.
Michelson said business trends follow a bell curve of innovators, early adopters, early majority and then late majority. He said that the "tipping point" -- where critical mass is achieved -- generally occurs between the early-adopter and early-majority phases when there is a market penetration rate of about 20% to 30%. "This study clearly supports the fact that this market has tipped," Michelson said.
Researchers asked the groups to rate what effect various possible government actions could have on the implementation of EMRs, and none of them -- including direct financial assistance -- received an "important" or "very important" rating. Michelson highlighted a statement researchers made regarding that finding in its report: "Perhaps federal action is less important than one might think."
But Jessee said one obstacle to wider adoption is a prevailing opinion that the savings accrued by EMR use will benefit the government or private insurance companies and not the doctors who paid for the systems.
Joseph Heyman, secretary of the American Medical Association's board of trustees and vice chairman of the Joint Commission on Accreditation of Healthcare Organizations' technology task force, said that government action to eliminate this perception would certainly help the cause.
"Physicians are thrilled to accept this technology if you can help them install it and pay for it," said Heyman, an obstetrician-gynecologist in Amesbury, Mass., who has used an EMR system since 2001.