Doctors Seek Guidance on Electronic Records

SAN FRANCISCO—Physicians use outmoded procedures to treat and monitor chronic conditions. Thats according to Sophia Chang, director of the Chronic Disease Care Program at the California HealthCare Foundation, who addressed attendees at a conference Thursday on improving chronic disease care.

Once evidence has shown a treatment to be effective, it takes 17 years to become part of routine care, Chang said, quoting a study from the Institute of Medicine. Computerized clinical support systems could reduce the lag time, she said, especially if the systems could tap into a patients medical record.

But the health care delivery world is not integrated, and these problems require a systemswide solution, she said. “The challenge is, how do you try to create this system in a fragmented world” in which hospitals, outpatient physicians, specialists and other entities simply dont communicate?

“The big bugaboo is physician adoption,” said Mark Leavitt, director of ambulatory care at HIMSS (Healthcare Information and Management Systems Society), a nonprofit professional group.

Even though rates for using health IT in physician offices remain low, he said, belief in its usefulness has risen. Doctors at conferences now want “fewer talks on why EHR [electronic health records] and more on how to implement it,” he said.

Leavitt described the barriers to adoption as a “logjam” between IT vendors, health care providers and health care payers. Payers are becoming more willing to compensate doctors more for using health IT products, but “they cant just write a check to everyone who has a computer.”

Vendors cant sell a $1,000 computer system without providing implementation and on-site customer support, and physicians are afraid theyll make the wrong investment.

Leavitts group is working on a certification program to help solve these problems, he said, but certification itself wouldnt be enough.

Next Page: The national health IT coordinator calls for small-office solutions.

Small Offices

David Brailer, the national health IT coordinator, said many of the products now on the market arent feasible for small physician offices. “Ive called on vendors to show me a $700/month product that is functional. We cant take these big, complex products and just scale them back slightly.”

Brailer said free, open-source programs—such as VistA from the Department of Veterans Affairs—could be an important catalyst, but that such programs use depends on the market segment.

“Its being adopted in public health clinics where there is a technology barrier, but its not getting play in hospitals and physician offices,” he said. More important than sharing software from [Veterans Affairs] and the Department of Defense, he said, would be sharing know-how.

Jeff Flick, regional administrator for CMS (Centers for Medicare and Medicaid Services), said disseminating expertise would not be easy. CMS offers small to midsized doctor practices free consulting services that provide help, expertise and financing for implement IT.

But he said only 256 out of 15,000 California physicians had contacted the program, called DOQ-IT (Doctors Office Quality Information Technology).

Later, in an interview with eWEEK.com, Flick said part of the reason for the low adoption is that the program is only three months old. Another, he said, is that only highly motivated physicians committed to changes are likely to take the initiative to contact his office.

Large employers also can be a force to drive adoption of health IT for safety and quality, said Jeff Rideout, vice president of Internet business solutions and medical director for health benefits at Cisco Systems Inc.

Cisco funds its own health benefits program and thinks EHR can save costs by preventing medical errors, encouraging preventive care and influencing the use of less-expensive drugs.

Rideout said Cisco would consider physician groups use of EHR in purchasing decisions, and the company wants to see covered doctors using key applications such as e-prescribing.

The location of the venue highlighted the growing difficulties in ensuring that Americans have health care. Originally scheduled for San Franciscos Palace Hotel, the conference was moved to the SBC ballpark after labor disputes over health benefits led several hotels in the city to lock out workers.

One audience member said even health care providers and payers committed to encouraging IT adoption are confused about where to start. “Theres so much going on in terms of pay-for-performance and certification. People are really not sure what groups should be doing right now.”

Some workers at public health projects worried that the focus on health IT is diverting attention away from more important issues, such as health care reform.

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