Medical Device Daily Washington Editor

WASHINGTON – There are many issues affecting the widespread adoption of electronic health records (EHRs) – cost, interoperability, compatibility, data safety, just to name a few.

For small- to medium-sized physician practices, the waters can be even murkier. Compared to large hospitals and healthcare systems, small practices often can't afford the technology, which can cost around $20,000, though prices are dropping.

And offering these systems are numerous vendors, all with competing proprietary software. Additionally, implementation of these systems can overwhelm a small, already overworked practice with limited technical resources.

Now, a pilot project funded by the Centers for Medicare & Medicaid Services (CMS; Baltimore) is reaching out to small- and medium-sized physician offices to help them move from paper-based health records to EHRs.

The Doctors' Office Quality Information Technology project, or DOQ-IT, is intended to educate physician offices on EHR system solutions and alternatives as well as provide information on the costs, risks and benefits of IT adoption.

Eighteen months into the two-year project, quality improvement organizations (QIOs) have been working with practices in four states – Arkansas, California, Massachusetts and Utah – to conduct a needs assessment and to identify EHR systems from multiple vendors that meet specific office needs.

Technical and quality improvement assistance includes uploading data, acquiring reports, and reorganizing physician office workflow to integrate and optimize IT use. Quality information gathered using the technology will be transmitted to CMS for review.

The agency says it is working on a pay-for-performance demonstration program through the DOQ-IT effort, in which physicians will report improvements for different chronic diseases.

CMS's QIO program consists of a national network of 53 contract organizations that work with consumers, physicians, hospitals and other caregivers to refine care delivery systems.

"The reason we're all in this is that we want to improve the quality of healthcare," said Jo Ellen Ross, president and CEO of Lumetra (San Francisco), lead QIO for the project and QIO in California. "Our success will be measured on the basis of looking at the data that comes out of the physician office in the area of quality."

Ross made a presentation about the DOQ-IT project at this week's healthcare quality summit here sponsored by the Agency for Healthcare Research and Quality (Rockville, Maryland), a division of the U.S. Department of Health and Human Services.

The four-state project will lead to national implementation with QIOs in each state beginning in August, Ross told Medical Device Daily.

The funding CMS provided for the project was about $3 million for California and about $1.7 million each for the other three states. Lumetra has been working with roughly 126 practices in California.

Participation is free, but applicants must complete an application and an EHR readiness assessment. Participants go through the selection and acquisition of a system – which the physician practice pays for – and EHR implementation and office redesign.

Ross said offices frequently have to be redesigned because they're organized for paper-based records management, which often can be "stuck in the '50s."

"I think the thing that surprised me the most is that we thought it would be difficult to recruit physicians to work with us in this developmental stage," Ross said. "[Physicians] are so eager to move in this direction and see the value in this long-term."

Justin Graham, MD, associate medical director for quality and information at Lumetra, called the interest by the vendor community another "surprise."

The American Academy of Family Physicians (AAFP; Leawood, Kansas) has been one of the partners participating in the DOQ-IT program.

David Kibbe, MD, director of AAFP's Center for Health Information Technology, and someone involved with the project since the beginning, told MDD that he's experienced "very good response" from vendors as well.

"We have had a dialog with these companies for about two years, and we have made a lot of progress," he said.

Kibbe said AAFP has been working with EHR software vendors on issues surrounding interoperability and commonality to ensure quicker adoption by physician practices.

"As the months go by we are seeing adoption becoming less and less problematic for these doctors," Kibbe said. "We are over 15% of the members of the academy using electronic health records and all of the vendors are telling us that they are selling systems in record rates to family physicians."

Kibbe expects 30% of AAFP's members to have EHR systems by 2006. "And that's probably a conservative estimate," he added.

Though cost is an issue, he said that adoption and implementation and their effect on productivity may impact physician EHR acceptance even more.

"These docs are weary about buying a system and then finding that it causes their practice to become less efficient or to see fewer patients per day," he said. "They are also very concerned about the viability of some of these [EHR] companies."

He said ASTM (Conshohocken, Pennsylvania), an international organization that develops standards for different industries, has developed a "continuity of care" record with the potential to bridge some of the gaps among competing software systems.

"I am a firm believer in the market and consumers with good information making good decisions," Kibbe said. "I think it is very incumbent upon us to try to create transparency so that the network of physician consumers is informed about price [and] quality, and we are able to continue to put appropriate pressure on the vendors to improve their products."

He said he believes vendors eventually will standardize their products enough so that EHRs are increasingly interconnected and able to act as the "central nervous systems" for practices, connecting them to pharmacies, laboratories and one another so that information can be shared easily at minimal expense.

Kibbe also said he believes government should act as a supporter of the process and not an enforcer of standards.

"I would hate to see the government come in with too heavy a hand," he said. "I would like to see the government be very encouraging of the private sector toward the development of interoperability standards and not enforce those standards. I think that's precisely what is happening right now – and it's working very well."