In April 2004, President Bush signed an executive order committing the federal government to promoting a national system of interoperable electronic health information technology, giving body to an announcement made earlier that month in which he set a goal that most Americans should have electronic medical records in 10 years.
Tuesday, with more than one-third of the allotted decade elapsed, a researcher from the Centers for Disease Control and Prevention in Atlanta gave a progress report on adoption by office-based physicians of EMR systems, an essential precursor to creating ubiquitous electronic patient records.
In short, the pace of EMR adoption remains glacial, according to the latest survey, a rate of adoption that wouldn't yield full EMR adoption by physicians in this century, much less in the next 6 1/2 years, according to one healthcare industry official who heard the report.
As part of its annual National Ambulatory Medical Care Survey, CDC researchers last year queried 3,350 nonfederal office-based physicians on IT usage. The results were included in a CDC report released last month. Jane Sisk, the CDC research director overseeing the survey, presented highlights of the agency's findings to the American Health Information Community.
According to Sisk, 29.2% of all physicians surveyed reported having some form of full or partial EMR in their practices. That's up 23.9% from the 2005 survey, which was reported last year. The percentages of adoption of "any EMR" from prior years including 2001 when the surveyor began asking about EMR adoption are: 20.8% in 2004, 17.3% in 2003 and 2002, and 18.2% in 2001.
Sisk is director of the Division of Healthcare Statistics and the National Center for Health Statistics within the CDC, which is itself a part of HHS.
What exasperated several members of AHIC, however, were the usage rates of EMRs deemed "minimally functional" for a comprehensive EMR, that is, systems that can record clinical notes, complete computerized orders for prescriptions, laboratories and radiology, and view laboratory and imaging results. The CDC surveyors have taken note of physician use of these minimally functional EMRs in its annual surveys only for the past two years.
Just 12.4% of all physicians in the latest survey reported using all six of those minimum functions, "a figure not significantly different from the 9.3% reported for 2005," the report said. The percentage varied widely by practice size, with the larger the group, the higher the rate of penetration for these minimally functional systems. For example, 27% of practices with 11 or more physicians use minimally functional systems, but just 7% of solo physicians and 10% of two-physician practices reported using them.
That distribution is particularly bad news in light of Bush's goal, since according to Sisk's numbers 34% of physicians are in solo practice and another 12% work in two-physician offices. One key tenet of the Bush executive order was the creation of the Office of the National Coordinator for Health Information Technology at HHS, tasked with developing a plan to promote Bush's national healthcare IT agenda. But another tenet was that ONCHIT could "not assume or rely upon additional federal resources or spending to accomplish adoption of interoperable health information technology."
Clearly, that spending prohibition has not been strictly adhered to, evidenced by the many millions of dollars in federal grants that have been awarded by ONCHIT as well as various divisions of HHS since 2004.
That would include the announcement last week that the CMS was launching a pilot program in 12 communities involving 1,200 physician practices indirectly aimed at boosting EMR adoption by awarding Medicare bonus payments for reporting quality measures. Under the plan, adoption of EMRs would facilitate collection and reporting of data to qualify for those payments.
Also presenting at the AHIC meeting was David Blumenthal, physician director of the Institute for Health Policy at 902-bed Massachusetts General Hospital, Boston. The Institute, along with the Harvard School of Public Health, George Washington University and RTI International, are also conducting a national survey of EMR adoption.
Based on results from an early sample of the incomplete study, Blumenthal said 69% of physicians surveyed cited a lack of capital as a major barrier to EMR adoption; 56% said they had difficulty finding a system to meet needs; 55% expressed uncertainty that the investment in an EMR would produce an economic return; 47% were concerned the system would become obsolete; 39% worried about loss of productivity; 37% had doubts about their capacity to implement an EMR system; and 33% noted physician resistance, presumably by colleagues.
Part of the discussion at the AHIC meeting Tuesday centered on what one AHIC member called the "500-pound gorilla" in the room, that the federal government as the largest payer and purchaser of healthcare in the country, could mandate physician use of electronic prescribing systemsone of the six EMR minimum functionsas a condition of participation in its Medicare, Medicaid and employee benefits programs.
Chip Kahn, president of the Federation of American Hospitals and an AHIC member, said physicians would not achieve as much as 40% adoption of e-prescribing systems without being compelled to do so.
"It ain't going to happen unless the government, the payers or the patients want to pay for it, because it just doesnt fit in their (physicians') economics," Kahn said.
But HHS Secretary Mike Leavitt, who serves as AHIC chairman, expressed reservations about doing that, although he indicated interest in what level of adoption would constitute a "tipping point" of adoption. Leavitt asked members of the panel to continue discussing the subject.
Members of AHIC went on to unanimously adopt a recommendation to Leavitt that he seek legislation from Congress mandating the use of e-prescribing systems.
No one made mention of the 800-pound gorilla, however: whether the Bush administration would call on Congress to also fund the mandate.
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