What's the secret to the adoption of information technology in small physician practices? You could have learned the secret in a hard-to-find conference room tucked away between the Philadelphia Marriott Downtown Hotel and the Pennsylvania Convention Center. There, for two hours on Oct. 28, researchers under contract with the federal government presented the preliminary results of an economic model they're building to predict physician practice use of IT.
It was an invitation-only presentation not listed in the official program guide to the Medical Group Management Association's annual conference, which was being held at the convention center. Only 50 attendees of the MGMA's conference were invited; by my count, only 24 showed up. I didn't receive an invitation but the door was open and there were plenty of empty seats.
Here's what I found out. HHS' Office of the Assistant Secretary for Planning and Evaluation awarded an approximately $600,000 contract to a company called MDM Strategies based in Merritt Island, Fla. Rosemary Nelson is the president and chief executive officer of MDM Strategies, and Nelson moderated the presentation in Philadelphia. The HHS project officer overseeing the contract is Suzie Burke-Bebee. Burke-Bebee, a registered nurse, is a senior health informatician in the HHS assistant secretary's office. MDM Strategies is working with two subcontractors to develop the predictive model of IT use by small physician practices, which the parties involved defined as having 10 physicians or less.
The first subcontractor is DecisionQ Corp., a data-mining and analysis firm with offices in Washington and Kentfield, Calif. John Eberhardt, a DecisionQ executive vice president, participated in the presentation as did Loretta Schlachta-Fairchild, president and CEO of iTeleHealth, the second subcontractor. Based in Frederick, Md., iTeleHealth develops a variety of telemedicine teaching tools.
The HHS contract runs from September 2006 through June 2008 with a final working predictive model due to the government by March 2008.
At the presentation, Eberhardt demonstrated the second version of the preliminary model to the two-dozen attendees. Here's how it works. The researchers to date have identified what essentially are 113 variables that affect whether a small physician practice will buy, install and use an electronic medical-record system (see very complex chart). Some examples of variables are cost, physician demographics, payer mix, availability of IT training, specific EMR functions, etc. Some variables are more predictive than others, and various combinations of variables are even more so. The goal of the contract is to tell the federal government which variables to pursue and in what combinations to help achieve its stated objective of wiring up the entire healthcare system by 2014.
When I asked Burke-Bebee at the presentation in front of the group, based on what she has seen, what recommendations she would make to HHS Secretary Mike Leavitt, she deferred comment to HHS' Office of the National Coordinator for Health Information Technology. Two days after the presentation, Leavitt announced a five-year demonstration project to provide financial assistance to up to 1,200 physicians in small- to medium-size group practices to start using EMRs. Presumably, Leavitt didn't rely upon the test version of the predictive model to decide to create the new demonstration project because its not finished. Or did he? If he didn't, then why spend the $600,000 on a predictive model of physician IT use if you're going to ignore it and make decisions without it. If he did, there's more to this project than we know.
Burke-Bebee said, in classic bureaucratese, that the preliminary results from the model are "confirming much of what we know. But there's a lot we don't know." In a follow-up conversation though, she couldn't help but gush via e-mail: "This is a very cool project."
And it is. The model, when finished, would be pure gold to anyone selling IT systems to physicians. It would tell them what series of buttons to pushexpensive systems but free trainingand whom to push (independent practitioners or salaried physicians) to entice small practices to buy their systems. Same goes for anyone or any organization wanting doctors to adopt IT just because its good for patient care.
But I cant help but think that the model will never see the light of day and will be filed away in some secure government computer system much like the fate of the ark of the covenant at the end of "Raiders of the Lost Ark." If that happens, it would be a shame. The model deserves to be part of the public record and made available to anyone who wants it. Taxpayers footed the bill, and patients ultimately will benefit from it.
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