Physician Groups Warming Up to HIEs

As electronic medical records systems make their way into healthcare's regular workflow, two recent, but separate surveys show that physicians may be buying into the value of joining health information exchanges.

Last week, Doctors Helping Doctors Transform Healthcare, a non-profit group focused on using technology to improve the healthcare quality, issued Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care, a 30-page report on how and when physicians say they want to use electronic health information.

Perhaps what is significant about this survey is not what it shows, but what it doesn't. The barriers to using and exchanging health information electronically are no longer rooted in maintaining the status quo. The fear of change that often accompanies shifts from manual systems to digital processes seems nearly gone.

Instead, physicians now say the challenges lie in the limitations of technology. That's a noteworthy change in attitude considering that in 2010 less than 50% of physician groups were using EMRs, according to the fourth annual Ambulatory Electronic Health Record & Practice Management study.

That number is now at 69%. That same survey also shows 56% percent of hospital-owned physician groups say they plan to join a state, hospital, or regional HIE. 

Both reports together show EMRs and HIEs gaining ground, due, in no doubt, to meaningful use requirements and industry changes. Michael Barr, MD, Senior Vice President of the Division of Medical Practice, Professionalism and Quality for the American College of Physicians, is on the advisory board of Doctors Helping Doctors.

He says the secure movement and availability of patient data is increasingly important because of the focus on population health management.

"New models of care, such as the patient-centered medical home and the medical home neighborhood are based upon building teams inclusive of patients, families and caregivers, and the success of these new models will depend on health IT infrastructure that supports seamless coordination of care, patient engagement, and clinical information. You can't do team-based care unless everyone has access appropriately."

The survey that Barr's group analyzed showed the top three barriers to sharing information electronically, according to physicians were:

• Lack of interoperability among other systems
• Lack of information exchange infrastructure
• Cost of setting up and maintaining interfaces

What's missing from the list? The business case, though to be fair, it still is a concern. And, while HIEs are not so widespread and mature as to collect decades-worth of ROI breakdowns, there is anecdotal evidence of savings.

If physicians' perspectives of inoperability and infrastructure challenges can be overcome, then stand-alone physician groups may be more apt to join HIEs. That group was less likely to join an HIE.

Janet Marchibroda, Chair of the Health Information Technology Initiative at the Bipartisan Health Center, which worked with the Doctor Helping Doctors, says consolidation may force smaller practices to evolve, technologically.

"I think that there's a lot of evidence that indicates that the adoption of electronic health records is difficult for small physician practices because it can be capital-intensive. That may be a driver for a physician practice to either join with other, larger practices or to utilize an EHR system provided by a hospital," she says.

Marchiboda also says stage 2 meaningful use requirements will help overcome the obstacles most physicians named.

"The good news is stage 2 actually has very robust requirements to certify EHR technology. Technology being federally certified before it can be sold for clinicians to use will help address concerns about interoperability," says Marchiboda.

Stage 2 MU requirements, recently released and delayed by a year, are not without detractors. On Thursday, four Republican U.S. House members sent a letter to HHS Secretary Kathleen Sebelius asking her to halt MU incentive payments, in part, because of interoperability concerns. The letter states, "We believe that the Stage 2 rules are, in some respects weaker than the proposed Stage 1 regulations released in 2009."

The letter is signed by Dave Camp, Chairman of the Ways and Means Committee, Wally Herger, Chairman of the Ways and Means Subcommittee on Health, Fred Upton, Chairman of the Energy and Commerce Committee, and Joe Pitts, Chairman of the Energy and Commerce Subcommittee on Health. 

It's not clear if the federal certification requirement Marchiboda referred to alleviates the concerns expressed by the congressmen.

In his address at the Bipartisan Policy Committee's event discussing its survey results, Farzah Mostashari MD, National Coordinator for Health Information Technology, said, "Stage 2 is you start sharing. Over the past two years, we worked really hard to make it possible to have standards, consensus standards."