Managed Care - October 2008 - (Page 5) LEGISLATION & REGULATION Doctors Say Getting Wired Too Costly, Time-Consuming President Bush wanted widespread adoption of electronic health records by 2014, but that’s clearly not going to happen By John Carroll W hen Barbara Walters, MD, senior medical director at the DartmouthHitchcock group practice in New Hampshire, took center stage at a recent news conference to describe the effect that an electronic medical record system had on the practice, she was quick to praise the rewards that could be reaped when doctors have ready access to patient information. Improved quality and better efficiency in handling diabetes cases was clear, she said, and the patient outreach efforts the technology enabled clearly brought down the number of hospitalizations and medical crises experienced by the group. “Patients adore this service,” added Walters, whose practice was participating in a Medicare-sponsored demonstration program on EHRs. “They like getting calls from their doctor’s office.” That’s all music to the ears of the champions of health care technology. Four years ago, President George W. Bush outlined a vision in which every American’s health record would be electronic by 2014. Along the way the technology revolution would rein in costs, reduce the frequency of troubling medical errors, and ring in a new era of high quality medicine. However, after years of endorsements and a string of bullish case studies, new research indicates that there is a yawning gap between the industry’s enthusiastic electronic pioneers and the majority of physicians working in small practices who still see no way around the big obstacles looming between themselves and the world of high-tech record keeping. Surveying 2,758 doctors in late 2007 and early ’08, a research team at the Institute for Health Policy at Massachusetts General Hospi- tal discovered that only 4 percent of physicians had a fully functional system that could satisfy some of the basic standards set by the Certification Commission for Healthcare Information Technology. The study, which was supported by the Office of the National Coordinator for Health Information Technology (CCHIT)and was published in the New England Journal of Medicine, did find reason for optimism: 17 percent of doctors used some kind of EHR system, 16 percent had acquired a system but hadn’t booted it up yet, and 26 percent volunteered that they planned to buy one inside of two years. The survey didn’t try to identify physicians who had fully CCHIT-certified systems because that would have excluded many physicians. Instead, it came up with a list of 17 functions that met their criteria for a fully functioning system. “The physicians with these records were generally happy about them,” says Catherine M. DesRoches, DrPH, lead author of the NEJM article. “But this is a very small group. They’re the true believers, the early adopters.” Bigger practices They are also typically working in big practices that have the financial resources to size up the potential for an electronic health record and how it can pay for itself through improved efficiency. But once you move out of large urban areas and away from those large practices, says DesRoches, you find physicians on Main Street America who are much less likely to know others who have a system and don’t have the money to buy one or the time to implement it. Many fear getting stranded with obsolete, expensive technology. DesRoches isn’t the only researcher to detect deep-seated skepticism among physicians. OCTOBER 2008 / MANAGED CARE 5
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