Navigating the IT river

The leadsman's cry, "By the mark, twain," signaled a depth of two fathoms. It meant there was sufficient water running beneath the riverboat, but not so much that it couldn't soon run aground. (It also inspired a famous author's pen name.)

A similar cry, I think, went up Tuesday from healthcare providers, most of whom are early adopters of health information technology systems.

They told members of a federal advisory work group that they and their provider organizations were paddle-wheeling ahead, following the course piloted for them by the federal electronic health-record subsidy program. But most shared their anxieties, too.

I wrote yesterday about what three physician group leaders said. I'll be blogging today about additional physicians' presentations and later about hospitals.

The witnesses who testified about how challenging things were for them are all health IT leaders from organizations with years and in some cases decades of experience with EHR systems. Even for most of them, it's not a pretty picture. Think of how perilous a trip this is becoming for those folks farther down the IT adoption curve.

Dr. Scott Hammer is the co-founder of Southern Delaware Medical Group, a four-physician family practice in Dover and Milford. The group has fully implemented a suite of integrated scheduling, practice management and EHR systems from A4 Health Systems, now part of Allscripts, at "significant personal expense," Hammer said.

The group has "seen some return" on its investment, Hammer said. But he added that his vendor is charging an additional $1,500 for its meaningful-use package setup fee, plus another $200 per doc for meaningful-use reports. Patient portals run about $1,000 per provider to set up, plus another $100 to $200 per provider a month to maintain. Local tech support—and there will be more than normal needed to set up the systems for meaningful use—run $100 an hour.

Hammer wonders whether the meaningful-use payments could be eaten up by the additional costs of participation in the federal program. He said his group has "taken our share of leaps of faith" and wonders whether this might be another.

Another to testify was Dr. Scott Monteith, a Michigan psychiatrist.

Monteith, a self-described technology booster, has served as a juror testing EHR systems with the Chicago-based Certification Commission for Health Information Technology. He said he hasn't written a paper prescription since 1999.

"I'm using a computer to take my notes," Monteith said during the meeting. "So, there is no question in my mind that health IT can be incredibly helpful in certain situations."

But, he argued, the government is pushing too hard, too fast. Too many providers are unprepared to adopt EHR systems, and vendors' systems need more research and development before they're ready for widespread use.

"Seventy-five percent of all scripts in Michigan are written by doctors groups of four or fewer physicians,” he noted. “I think we're trying to do the impossible.”