Electronic Health Records

Adoption & Implementation News

Why are solo physicians half as likely to adopt EHRs?

By Jennifer Bresnick

In news that may not come as much of a surprise to anyone who works in a smaller medical practice, the Commonwealth Fund has produced new data that shows solo physicians are about half as likely to have adopted EHR technology than larger groups of primary care providers.  Practices of twenty or more physicians currently boast an overall EHR adoption rate of 90%, while only one in two independent practitioners has access to such technology.

Though small practices have been aided by regional extension centers (RECs) and encouraged by incentive payments, the larger integrated delivery networks and those practices that have spread the financial burden of health IT adoption between them have still been significantly more successful in overcoming the barriers that consistently plague the little guys.

The data, collected from 2009 to 2012, confirms that the obstacles facing small practices haven’t gone away despite the $18 billion in incentive payments CMS has poured into the industry.  Enormous initial financial outlays to upgrade computers and build infrastructure are simply not possible for many solo practitioners operating on razor-thin margins.  Despite the work of RECs, which provide valuable guidance during the process of picking an EHR, adapting the office, and meeting the challenges of meaningful use, physicians must take a great deal of monetary responsibility on their own shoulders for the success of these projects.

Physicians who read horror stories of bankrupted hospitals and tanking credit scores may not wish to risk the business they have often built up from nothing.  Older providers who are close to retirement see little reason to invest in technology that is difficult to learn and won’t be used long enough to provide a return on the outlay.  Those who go consider EHR use with a negative attitude often reap what they sow, adds a study conducted by AHIMA.

For these physicians, that means that the financial issues may be secondary to the impact on their workflow.  Patient interaction may be particularly important to physicians who choose to work in independent settings, and it’s no secret that the rapport changes when a laptop enters the room. Research from Northwestern University confirms that EHRs become absorbed in their computer screens to a high degree, frustrating patients who rely on a personal connection in order to most actively participate in their care.

“When doctors spend that much time looking at the computer, it can be difficult for patients to get their attention,” said Enid Montague, lead author of the study. “It’s likely that the ability to listen, problem-solve and think creatively is not optimal when physicians’ eyes are glued to the screen.”  The study, published in the International Journal of Medical Informatics, showed that physicians who use EHRs spend about one third of their time with their eyes on the laptop.

But solo physicians who accept Medicare may start regretting their decision once financial penalties for non-participation in the EHR Incentive Programs start to add up.  Two percent of Medicare reimbursements might not seem like a killer, but CMS also requires participation in a variety of electronic quality reporting programs that get much easier when a provider uses an EHR.  Those who opt out or drop out might find up to 10% of their reimbursements stop coming through the door, and that can be a major problem for those cash-strapped solo docs with aging patients.

While the deadlines are drawing nearer to avoid the worst of the penalties, independent physicians who may be on the fence about EHR adoption still have plenty of resources available to them, and they are not alone in reporting significant bumps along the rocky path towards health IT maturity.  “New challenges emerge as providers progress toward Meaningful Use, creating opportunities to preempt large-scale issues with timely interventions,” says the REC and EHR adoption study co-authored by former National Coordinator Farzad Mostashari.  “If identified quickly and a time response is provided, problems may be halted before becoming widespread or impeding progress.”




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