CHICAGO, Feb. 2 /PRNewswire-FirstCall/ -- An online survey of 1,888 physicians, medical group executives and staff, released today by Allscripts, concludes that U.S. physician groups are eager to accept a proposed multi-billion dollar package of government loans, grants and incentives designed to promote broader adoption of information technologies such as the Electronic Health Record (EHR).
The survey results reveal consensus among medical groups that funding is critical, with 82 percent of respondents strongly agreeing that the government should provide funding for Electronic Health Records via the HITECH(1) Act, a key component of the proposed $825 billion economic stimulus package now under consideration in the US Congress.
The survey also confirms that existing incentive programs managed by the Centers for Medicare and Medicaid Services (CMS) -- designed to encourage hospitals to donate EHRs to physicians and to spur adoption of electronic prescribing (e-prescribing) -- have been effective. But on several key issues that are central to the debate underway in Congress, the survey reveals a wide variance in opinions among respondents. This is especially true when it comes to deciding what form of payment the government should provide, whether funding should be targeted toward the purchase of an EHR or incentives for use of an EHR.
As a result, the survey findings clearly suggest the most effective route to achieving widespread EHR adoption lies not in a uniform approach to all physicians but rather a blended model of incentives that address the unique needs of different physicians in different types of medical groups.
"This survey provides the first comprehensive look at the views of physician practices related to the HITECH Act under consideration in the US Congress," said Glen Tullman, Chief Executive Officer of Allscripts. "The results confirm our view that providing physicians with the incentives to invest in and use an Electronic Health Record is the single most important action we can take to improve the quality, enhance safety, and lower the cost of healthcare in America. A critical point is that physician practices of different sizes and technical maturities have different needs. If we want to rapidly improve our healthcare system using technology to connect all US physicians to each other, to their patients, and to the latest information in real time, then it is important that Congress recognize the different obstacles to adoption that exist and frame a solution that meets the needs of all healthcare providers. This survey, direct from medical groups, provides clear guidance on just how to do that."
The goal of the survey was to gain insight into the perspectives and preferences of healthcare professionals related to the current incentives in place and the new proposed incentives for adoption and utilization of EHRs, as well as privacy and security considerations.
Key findings included the following:
-- Healthcare professionals support government incentives. Eighty-two percent of respondents strongly agree that the government should provide funding for EHRs via the HITECH Act.
-- Current e-prescribing incentives are working. Seventy-five percent of respondents to the survey are aware of the current e-prescribing incentives from the Centers for Medicare and Medicaid Services (CMS), and 37 percent are actively participating in the program.
-- Current EHR subsidies provided by hospitals are effective. Over 10 percent of practices surveyed have already received an offer from a hospital to help subsidize the cost of an EHR for their group under the Stark Safe Harbor exception. The 2008 CCHIT Incentive Index(2) identified 50 programs nationally involving 115 hospitals that are currently providing funding for physicians. Taken together with the Allscripts survey, this data provides an indication that the current program has gained traction in the market. However the new programs under consideration have the potential to greatly more significant adoption.
-- The proposed incentives may drive significant new adoption. Sixty-eight percent of respondents would be likely to participate in the pay-for-purchase proposal under consideration in the Stimulus Bill, which provides sliding scale financial incentives resulting in payments of up to $40,000 per provider over 5 years as reimbursement for the purchase of an EHR. Only 2 percent of respondents indicated they would not participate in this program, with the remainder either unsure (25 percent) or unlikely to participate (3 percent).
-- Groups without an EHR have equal preference for either a pay-for-purchase or pay-for-use. Respondents from medical groups that do not have an EHR expressed an equal preference for either a pay-for-purchase or pay-for-use approach. Among all groups surveyed, preference for pay-for-purchase decreased in direct correlation with practice size: 47 percent of respondents from groups with between one and three physicians preferred to be reimbursed for purchasing an EHR rather than provided incentives for its use; 32 percent of those from groups with between four and 25 physicians agreed; 20 percent of those from groups with 26 to 100 physicians agreed; and just 18 percent of respondents from groups of 100 or more physicians agreed, with the larger groups strongly favoring utilization incentives.
-- Providers are confident in existing privacy and security protections. Sixty-one percent of respondents from groups with an EHR say they want to move forward without waiting for new privacy standards, expressing confidence in their EHR's existing privacy protections. The results suggest that, while privacy breach will always be a concern, experienced EHR users have faith in current protections including the Healthcare Insurance Portability and Accountability Act (HIPAA), and the EHR certification process managed by the Certification Commission on Healthcare Information Technology (CCHIT).
-- Existing EHR users should qualify for incentives, too. Seventy-seven percent of small-group respondents and 82 percent of large-group respondents (81 percent overall) recommend incentives from the government to retroactively cover the cost of existing EHR implementations.
-- Medical groups should be able to use funding to upgrade existing EHRs. Seventy-three percent of all respondents support government funding to upgrade existing EHR implementations.
Based on these results, the survey suggests that the new federal programs now under consideration in Congress would be best served by:
-- providing up-front grants for EHR purchase as well as ongoing incentives for utilization, as groups with different characteristics appear to be motivated by different approaches
-- including retroactive funding for practices that have already adopted EHRs, as this will drive utilization of the EHR the benefits accrue to patients, providers and to the Federal Government
-- helping practices with older or low-functioning EHRs to upgrade to more current or fully-functioning systems as many early adopters may not have the capital to meet the current standards that may be required in a pay for performance or pay for use program
-- relying on existing privacy protections for patient information rather than waiting for new policies to be agreed upon, with the understanding that there are currently extensive security standards built into the CCHIT certification process
A white paper detailing the survey's findings in more depth can be downloaded for free at: http://www.allscripts.com/connect.
Quotes from Survey Respondents
The following comments on the survey were selected from the hundreds of respondents who left comments and provided permission to have them published:
"The EHR has demonstrated unequivocally the savings of lives and dollars," said one survey respondent, Joel I. Silverman, a physician at Adult Medicine of Broward and Palm Beach, in Deerfield, Fla. "We're overdue for a major shift in how physicians are practicing and are being paid for their efforts."
"The EHR is the only answer for improved and more efficient medical care," said Cathie Lentz, practice administrator at Elmwood Center Medical Associates in York, Penn. "Unfortunately the cost is out of reach for most physician offices."
"I do think standards for privacy need to be developed, but this should not hold things up since we already comply with HIPAA and take this into consideration presently with our system set up," said Patricia L. Fox, practice administrator at Croser Keystone Health Network in Chester, Penn.
"Rapid adoption of an EHR is critical to improving the health status and
outcomes of the patient population we serve," said Chuck Fitch, Chief
Information Officer of the
"When I started my solo practice in 2004, I took out extra loans to purchase an EHR, which cost around $80,000 including computers and server," said Chris Buchanan, a physician at Brazos Urology Clinic in Granbury, Texas. "I think it would be unfair to pay doctors to purchase new EHR systems without rewarding doctors who have had them for years. The fact that I have a system improves the quality of the care that I deliver through reduced errors, 24-hour access to patient charts when on call, etc. Therefore an incentive should be given to all doctors who use EHRs."
"I recommend use of any subsidy be applied toward one-time expenses such as implementation training or license costs," said Mark Gilbert, Director of Operations at Practicare Medical Management Inc., in Liverpool, New York. "Ongoing maintenance expense should not be covered. ... I would be against the stimulus being used toward fee schedule adjustments as the beneficiaries would be the practices that already have an EHR. Providers need the monies to get an EHR off the ground."
"A program that only rewards new purchasers of EHR's is quite unfair to those who have already taken the plunge and paid for the systems themselves," said Jeffrey Johnson, MD, Medical Director of Central Utah Clinic, in Provo, Utah and a former Microsoft Health Users Group Physician of the Year award winner. "We have done much of the work to help EHR technology get to the advanced stage of development it's in today, and to not recognize that and only reward the Johnny-come-lately's in an incentive system would be grossly unfair."
"The stimulus bill may be the single most effective way to assure improved quality and cost of healthcare," said Larry Wiley, a staff member at Washington Regional Medical System Clinics in Fayetteville, Ark.
Survey Methodology and Demographics
The survey invitation was sent via email to 50,000 healthcare professionals in more than 13,000 medical groups. Conducted in January, 2009 by Allscripts, the Internet survey of 18 questions generated 1,888 respondents, including:
-- 242 C-level executives, 304 providers, 313 information system professionals, and 1,029 practice administrators, managers and other staff.
-- Participation from practices of all sizes with 444 respondents in practices with 1 to 3 MDs (24 percent), 894 with 4 to 25 MDs (47 percent), 284 with 26 to 100 MDs (15 percent), and 266 with over 100 MDs (14 percent).
-- A variety of practice types including 801 single specialty (42 percent), 596 multi-specialty (31 percent), 423 primary care (22 percent) and 71 "other" types (4 percent).
-- Groups that currently had an EHR (1,148 or 60 percent) outpaced those that did not have an EHR (740 or 40 percent) due in part to the significant EHR user base of Allscripts, although we did not measure the number of EHR users in the survey who use Allscripts EHRs.
All survey participants work in medical groups utilizing either EHR, e-prescribing, practice management, revenue cycle management, document management, or medication services products from Allscripts.
Allscripts (Nasdaq: MDRX) uses innovation technology to bring health to healthcare. More than 150,000 physicians, 700 hospitals and nearly 7,000 post-acute and homecare organizations utilize Allscripts to improve the health of their patients and their bottom line. The company's award-winning solutions include electronic health records, electronic prescribing, revenue cycle management, practice management, document management, medication services, hospital care management, emergency department information systems and homecare automation. Allscripts is the brand name of Allscripts-Misys Healthcare Solutions, Inc. To learn more, visit http://www.allscripts.com.
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(1) The Healthcare Information Technology Economic and Clinical Health Act (HITECH Act) is part of the American Recovery and Reinvestment Act ("the Stimulus Bill"). (2) http://ehrdecisions.com/wp-content/files/CCHITIncentiveIndex20080925.pdf Available Topic Expert(s): For information on the listed expert(s), click appropriate link. Glen Tullman https://profnet.prnewswire.com/Subscriber/ExpertProfile.aspx?ei=80768
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