Department of health and human services: Doctors reluctant to make records high-tech

During a press conference two weeks ago outlining what the Senate would do in the wake of Hurricane Katrina, Majority Leader Bill Frist (R-Tenn.) observed that if victims of the catastrophe had electronic health records on file the medical response to the disaster would have been superior.

But new research funded by the Agency for Healthcare Research and Quality (AHRQ) suggests that doctors continue to be reluctant to use new information technology in their offices.

The high cost electronic health-records systems is the No. 1 reason they are not used more widely, the survey of medical-group practices shows.

There seems to be no disagreement that information technology promises to make healthcare better and cheaper. President Bush has pledged that all Americans would have access to electronic health records by 2014. Politicians of all stripes, from Frist and former House Speaker Newt Gingrich (R-Ga.) to Sens. Edward Kennedy (D-Mass.) and Hillary Rodham Clinton (D-N.Y.) have climbed aboard the healthcare information-technology bandwagon.

Organizations representing doctors in Washington said that doctors are under pressure to adopt costly, uncertain new technology even though Medicare is slated to cut their payments next year unless Congress enacts an expensive fix.

The physician lobby is emphasizing this point as it works to cajole Congress to block a scheduled cut in Medicare payments.

Doctors’ offices “are in the classic squeeze” as their costs rise but their payments are not keeping pace with expenses, said Pat Smith, senior vice president of government affairs for the Medical Group Management Association (MGMA).

The American Medical Association (AMA) is taking the same message to the Hill, said Joe Heyman, a Massachusetts-based physician who is secretary of the AMA’s board of trustees.

Physicians groups agree that, in the long term, electronic health records and other uses of information technology will save money throughout the healthcare system, but they caution that the short-term costs can be daunting, especially for a small office.

The AMA and the MGMA are asking Congress to consider providing tax incentives, such as credits, to physician offices that invest in electronic systems for health records and other applications.

“This is not a cheap, piece-of-cake deal,” Smith said.

The initial investment is about $32,000, and the monthly maintenance costs of $1,500 mount over time, according to the AHRQ-funded study.

The MGMA conducted the survey in conjunction with the University of Minnesota School of Public Health. The report appears in the latest edition of the journal Health Affairs, along with other articles on healthcare information technology.

Only 11.5 percent of the smallest practices use electronic health records. Larger practices are more likely to use them, but even among those with 20 or more doctors  only 19.5 percent have systems in place. Moreover, 41.8 percent said they had no immediate plans to use electronic health records.

According to an AMA survey conducted last year, 23 percent of non-group-practice offices use electronic health records.

“Of course there’s a capital outlay,” said Rick Tyler, a spokesman for Gingrich. “The idea that it will cost them money is just nonsense” because the investment will be recapped as their offices become more efficient.

Heyman emphasized that “the savings do take some time to come.” In the short term productivity actually declines, Smith said.

According to another study in the same issue of Health Affairs, of healthcare information technology could save $81 billion each year.

Tyler predicted that physicians eventually would adopt the emerging technologies. “All these doctors use IT in every other aspect of their lives,” he said.

“A lot of physicians are just scared to death” of changing their practices, Heyman  said.

Doctors are wary of the new risks such as losing data and compromising the confidentiality of patients’ information, Heyman said.

Nevertheless, he said, “it’s pretty clear that if you get rid of some of the concerns … physicians are more than happy to grab up this technology.”