D Healthcare Daily

More Texas Medical Association (TMA) physicians are using electronic tools to help them practice medicine than ever before, according to a preliminary TMA survey.

Sixty percent of Texas physicians report now using an electronic health record (EHR), up from 43 percent from 2009.

About half of physicians nationwide were using EHR by the end of 2011, according to a federal government survey, and half of those without said they planned to install them by the end of 2012. Only about one-quarter used them in 2005.

“TMA is pleased to see the good news that more physicians are using EHRs, because they can potentially help improve patient care,” said Joseph Schneider, M.D., chair of TMA’s Ad Hoc Committee on Health Information Technology. “But we are very disappointed that a significant portion [of doctors] are experiencing technology and usability problems that can threaten practice viability, patient safety, and continuity of care. For example, 25 percent of physicians were dissatisfied with the reliability of their EHR. For the EHR industry, this is extremely poor performance.”

More than half of physicians—55 percent—expressed dissatisfaction with productivity and the time required to input data. About half reported they are dissatisfied with the effects EHRs have on their practice costs.

“The steep price tag and fear that the technology will challenge the viability of their medical practice are some of the main reasons physicians are not installing EHRs,” said Dr. Schneider.

EHRs can be cost-prohibitive, regardless of federal incentives. The average EHR purchase cost is about $40,000 per physician, not including drops in productivity during installation and implementation that can hamper practice revenue.

Texas doctors have taken advantage of federal stimulus money. Forty-one percent of physicians indicated they qualified for the stimulus incentives and either received the first payment or expect to receive it. Of that pool, 45 percent of physicians applied for funds available through Health Information Technology for Economic and Clinical Health (HITECH) Act. Thirty-three percent applied for incentives from Medicare, which can amount up to $44,000. Twelve percent applied for incentives from Medicaid, which can add up to $63,750.

There has been growing opposition to providing stimulus money to physicians and hospitals. Last week, four Republican U.S. House leaders wrote a letter to Health and Human Services Secretary Kathleen Sebilius, suggesting that $10 billion spent so far on the program has failed to ensure that the digital systems can share medical information.

The Bipartisan Policy Center issued two reports disputing the claims made by the House leaders, saying that physicians see potential for EHR exchange to positively impact healthcare performance.

Physicians have adopted EHR at a rapid rate. However, according to a report by the ratings service Black Book Ratings, 97 percent of physicians and 80 percent of hospitals are “meaningfully disconnected,” meaning they are not sharing information regularly through a health information exchange.

The current generation of EHR appears not to be living up its hype. The market research firm KLAS found that about half of its 2012 survey respondents were not first-time buyers, up from 30 percent in 2011.

“Some providers are changing vendors simply because their whole organization is moving onto one platform,” KLAS’s Mark Wagner told American Medical News. “But the real sad story is the providers who are changing vendors because they can’t get the support they need or the functionality they expected.”

Savings claimed by EHR proponents also are elusive. Canadian researchers sifted through 31,000 studies of health information technology spanning five decades. They largely concluded that EHR had not improved health or saved money. For example, they found that physicians overrode EHR medication alerts from 50 percent to 97 percent of the time because they knew the drug interactions were harmless.

Despite the hurdles, most doctors understand the need to embrace electronic office tools. In TMA’s Healthy Vision 2020, Chris Crow, M.D., a Plano physician and D Healthcare Daily contributing editor, said, “Being in a paper world is the same as driving your car either without a dashboard or maybe even blindfolded. If you do not have feedback about how you are doing in your practice, whether it be financial, quality, cost, efficiency, or patient satisfaction, you can’t play in a game where cost and quality matter, which is what the national discussion is around.”

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.