A Commonwealth Fund report had some good news and bad news to impart on electronic medical record adoption by physician practices and a rather stark subtext for the solo physician practices that haven’t yet given up paper records for EMR.
On the positive side, from 2009 to 2012 the rate of adoption of EMR by U.S. primary care physicians rose from 46 percent to 69 percent, based on data from two surveys. The biggest shift was for order entry management such as ordering lab tests and transmitting prescriptions to pharmacies.
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But the report also notes that, based on a survey of 1,412 primary care physicians in 2009 and 1,012 primary care physicians in 2012, independent physicians have trailed practices of 20 or more on EMR adoption. Those larger practices have a roughly 90 percent adoption rate compared with 50 percent for smaller private practices, according to the report. What needs to happen for the remaining practices to adopt EHR systems?
Collaboration is key. The report points out a couple of collaboration options: Practices that are part of an integrated delivery system (like Kaiser Permanente or the Veterans Administration) or share resources with other practices, such as for programs for clinical information systems or quality improvement, have higher rates of HIT adoption. Although it doesn’t actually name them, the report may as well be talking about Independent Practice Associations.
The report concludes: “Technical assistance programs and financial incentives could help bring these physicians up to speed and enable them to provide high-quality care more efficiently.”
It would be one thing if the conversion to EHR was the only concern of small practices. But they are also faced with the challenge of the increased administrative workload of the Affordable Care Act. On top of that, how do they negotiate competitive prices with insurance companies? Those factors are driving private practices to join larger associations to survive — Independent Practice Associations in particular. The groups are helping small practices adopt electronic health record and health information exchanges. These groups are less about crafting strategy or policy to member practices so much as giving vision, leadership and assistance with activities members wish to pursue.
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The Meaningful Use incentive program outlined in the HITECH Act has used financial incentives to push EMR adoption and the Office of the National Coordinator for Health IT’s program to fund 62 Regional Extension Centers around the U.S. has helped with technical assistance in connecting primary care physicians to health information exchanges.
Affiliations with IPAs also offer a way for smaller practices to be part of the shift from fee-for-service to outcomes-based care and join and form Accountable Care Organizations.
While financial incentives have been part of the strategy to encourage small practices to adopt EHR, they’re only part of a much bigger reason why solo MDs have to collaborate or face a difficult future. For some physicians, the changes healthcare reform requires of them are simply too big to adopt and they will quietly fade away.
[Photo credit: Collaboration from BigStock Photos]
