Small Practices Need Big EHR Help

HealthLeaders Media Staff, June 25, 2009

It is not often that President Barack Obama and former Speaker Newt Gingrich publicly agree, but both have made similar arguments recently pointing to shipping company FedEx as evidence that electronic health record interconnectivity is possible. If FedEx can digitally track a package sent anywhere in the world, the argument goes, then why can't the U.S. healthcare system collect and track basic patient health information?

But comparing a single company to an entire industry isn't exactly apples to apples. FedEx is a massive corporation that has the economies of scale and capital to invest in state-of-the-art technologies. What about the rest of the shipping industry? A much smaller company that offers similar services—let's say an independent courier that delivers packages in New York City—has a more limited budget and runs a very different operation.

It's not a perfect analogy, but the point is most healthcare isn't provided by big businesses that have the resources of a FedEx. In fact, small medical practices provide about 75%-80% of ambulatory care in the United States. While implementing an EHR system can be complicated and expensive (even with federal incentives) in any practice, it is particularly challenging for small and solo practices that can't spread the cost burden among a large group.

That's why only about 13% of small and solo practices have implemented EHRs, compared to 57% of physicians in practices with more than 50 doctors.

Federal officials charged with working out the details of the Health Information Technology for Economic and Clinical Health (HITECH) Act must account for this landscape and the unique challenges that small and solo practices face. Will $44,000 over several years even be enough to offset the costs of implementation for a single physician? Will an ambitious meaningful use definition set the bar too high for small physician groups?

A report released yesterday by the National Committee for Quality Assurance suggests that, while small practices are often willing to change in order to improve quality, they lack the resources and need special attention and assistance.

Congress, to its credit, is looking for ways to help. Yesterday, the House Committee on Small Business held hearings about the specific challenges solo and small practices face in health IT adoption. Kathy Dahlkemper (D-PA), chairwoman of the Subcommittee on Regulations and Healthcare, oversaw the hearings and introduced the Small Business Health Information Technology Financing Act, which would establish a new program at the Small Business Administration to guarantee loans made to physicians seeking to invest in Health IT.

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