CSO Executive Summit

Survey: 58% of docs to roll out e-health records in next two years

The key drivers of EMR adoption are federal carrot and stick regulations

Lucas Mearian

March 2, 2010 (Computerworld) A survey released today by Accenture and Harris Interactive showed that 58% of physicians in small private practices plan to roll out electronic medical record (EMR) technology over the next two years, spurred by federal regulations that will first offer monetary incentives and then penalties.

The researchers surveyed 1,000 U.S. physicians in December who worked in offices with fewer than 10 practitioners. Nearly 80% of the respondents age 55 or younger said they planned to roll out EMRs in the next two years.

The purpose of the survey was to determine physicians’ concerns and perceptions of EMRs and gauge motivating factors at a time when federal legislation includes incentives for physicians who implement EMRs and penalties for those who do not adopt EMRs by 2015. Of the physicians surveyed, only 15% said they were already using EMRs. Overall, only 6% of private physician practices have fully functioning EMR systems in place, according to Accenture.

Accenture said the doctors who don’t use EMRs underestimate the cost and time requirements to implement an EMR system. And in comparison with the actual experiences of EMR users, non-users have an exaggerated perception of how difficult it is to use EMR systems.

Of the physicians who use EMRs, 90% indicated that the systems brought value to their practices because they offered an effective overview of a patient’s history. They also said that the systems allow quick and accurate data entry.

The federal government has released a 556-page draft rule that contains specifications and certification criteria for EMRs. Those rules, now available for public comment, set a four-year timeline beginning in 2011 for implementing the systems; they also spell out best practices. A final version of the government’s Notice of Proposed Rule Making helps define what type of technology should be used and spells out how $36 billion in incentives from the American Recovery and Reinvestment Act of 2009 should be paid out. A physician in private practice can receive up to $44,000 for rolling out EMR technology.

Physicians and hospitals that don’t roll out the EMR technology and prove that they are making “meaningful use” of it by 2015 face penalties in the form of reduced Medicare reimbursements.

Respondents to the Accenture survey said the federal regulations were the key factor driving EMR adoption, with 61% saying Medicare reimbursement penalties were spurring adoption and 51% attributing adoption to the incentive money.

Accenture and Harris Interactive conducted the survey, and the New York Academy of Medicine assisted with the qualitative survey and analysis.

Seventy-five percent of those surveyed who were not already using an EMR system said they were “intrigued by the idea of purchasing an EMR system from a local hospital,” if the purchase would be at least partially subsidized by the hospital. Those same respondents indicated that they expected hospitals or a health network to subsidize about half of the system’s cost.

“Our research indicates that, as intended, federal legislation is an important driver of EMR adoption among U.S. physicians,” Dr. Kip Webb, who leads Accenture’s clinical transformation practice, said in a statement. “If U.S. health care providers properly implement and use EMRs more broadly, there is no doubt that EMRs can make an important contribution to improving quality of care and controlling costs.”

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Getting certified

The nonprofit Certification Commission for Health Information Technology (CCHIT) is currently the only organization accredited by the U.S. Department of Health and Human Services (HHS) to certify that EHR systems in use at private physician practices and larger healthcare facilities meet meaningful use criteria. The HHS’s Office of the National Coordinator is currently working on new rules for accrediting other organizations to certify EHR systems.

“Until that happens, there can be no final certification of products that physicians and hospitals can rely on,” said Sue Reber, marketing director at the CCHIT. “So it looks like it’s being pushed pretty far back, and that creates a problem. If you’re a physician and you’ve already rolled out EHR under a previously accredited vendor… then all you have to do is get the product updated with the vendor’s newly accredited software [and if you] have fair amount of patient data to work with, you’ll be in pretty good shape.”

For hospitals, EHR certification is even more complicated. That’s because hospitals don’t rely on all-inclusive bundled systems like the ones that smaller practices purchase. At hospitals, technology is rolled out piecemeal and requires integration. Since many hospitals won’t consider ripping and replacing existing IT infrastructures, they’re forced to integrate new documentation systems, CPOE systems and relational databases with existing technology.

Most hospitals began using health information technology far earlier than smaller physician practices, but they purchased that technology department by department. A hospital, for instance, may have a patient admission system for its front office; a different patient transfer system for other departments; separate administration systems for the emergency room, the laboratory, the pharmacy and the radiology departments; and separate physician order entry systems. And all those systems may have come from different vendors.

The CCHIT, which has been certifying health IT systems since winning a federal government contract in 2006, is currently developing a program to be launched this summer called “Site Certification.” The program and accompanying services allow inspectors to check a hospital’s systems over the Web in order to certify them for meaningful use.

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Federal health care dollars

Hospitals and doctors must begin rolling out EHR systems this year or risk losing federal reimbursement money that will be paid out next year. As part of the American Recovery and Reinvestment Act of 2009, about $19 billion in incentives have been earmarked for electronic health records (EHR) systems. The Health Information Technology for Economic and Clinical Health (HITECH) Act allows for payments of up to $64,000 to each health care operation that deploys an EHR system and proves it’s being used effectively by January 2011.

Each year after that, the reimbursements through the Office of the National Coordinator (ONC) drop, so it behooves hospitals and physician practices to roll out systems as quickly as possible.

Larry Leisure, managing director for Ingenix Consulting, said EHR systems will be the driving force behind many of the wireless monitoring technologies soon to be available.

“They create a longitudinal health record,” he said. “One big benefit of EHRs is the e-visit. Imagine a patient and doctor having an e-mail conversation with bio-monitoring equipment transmitting data. They can have a conversation with shared information available to both. It enables patients and physicians to have a different relationship. Think about the cost avoidance in that.”

The Alzheimer’s Association recently unveiled a new Web-based application that works with mobile devices to track people suffering from dementia who wander off. The association’s Comfort Zone service is powered by Omnilink tracking services and is the first comprehensive location management system designed specifically for Alzheimer’s patients.

Evidence-based medicine

Electronic records help support “evidence-based medicine,” which allows the federal government to monitor how doctors treat patients based on policies and practices derived from the systematic, scientific study of standardized treatments. For example, it’s been known for years that patients should be prescribed aspirin after a heart attack, but there is currently no way of making sure that happens.

Standardizing on evidence-based order systems in order to qualify for federal money, or opening up access to personal health records on cloud computing networks, will allow doctors and patients to make better choices for care, said Kurt Miller, the global lead for Accenture’s health management solutions practice.

Health data uploads

Health monitoring vendor iMetrikus offers an aggregation service called MediCompass Connect. It is a telehealth gateway members can use to upload biometric data from over 50 personal health monitoring devices, including glucose monitors, insulin pumps, blood pressure monitors, digital spirometers, pedometers and weight scales. The system transfers data via a standard phone line or PC using a single-click connectivity hub. The data is then integrated with health management systems, such as disease and wellness programs, EHRs, provider practice tools and predictive modeling applications.

Wireless health monitoring

The emergence of consumer health electronics such as portable ECG devices, blood pressure monitors or weight scales can allow the seamless capture and sharing of patient information from home, at work or even on the road. Portable ECGs, for instance, weigh just 3.5 ounces and allow outpatients to record electrical heart signals and transmit the results to doctors who can monitor them for trouble down the road. Advances in microprocessors will allow such devices to connect wirelessly with home computers, mobile phones or even remote Internet applications.

Corventis Inc., a wireless monitoring device vendor, developed a wireless cardiovascular reader that looks a lot like a typical Band-Aid. The PiiX is water-resistant, adheres to the skin and automatically collects and transmits health data to a second, portable device that wirelessly sends the information to Corventis. It can then aggregate the data for analysis or pass it along securely to physicians or for inclusion in a personal health record.