New Survey Finds Costs Hinder Doctors’ Adoption of Electronic Records

The cost of switching from a paper-based health records system to an electronic version for patients is a key obstacle for many primary care physicians in the U.S., according to a study published on Wednesday in the New England Journal of Medicine, USA Today reports.

For the study, co-authors Catherine DesRoches and David Blumenthal of Massachusetts General Hospital in Boston surveyed 2,758 physicians nationwide (Davis, USA Today, 6/19).

According to the New York Times, the study -- funded by HHS and a grant from the Robert Wood Johnson Foundation -- found that the "slow adoption of the technology is mainly economic" as "especially those in the small practices lack the financial incentive to invest in computerized records."

According to the study, fewer than 9% of practices with one to three physicians -- which account for nearly 50% of all physician practices nationwide -- use an EHR system (Lohr, New York Times, 6/19).

The study, titled "Electronic Health Record Adoption in the Ambulatory Setting: Findings from a National Survey of Physicians," also found that 4% of all respondents had converted to a "fully functional" EHR system, which records patient information and demographics, allows physicians to view and manage laboratory results, manage orders such as prescriptions and assist with clinical decisions.

Thirteen percent of respondents had adopted a basic system, which might not have specific entry capabilities or the ability to offer clinical decision support, according to CQ HealthBeat (Wyckoff, CQ HealthBeat, 6/18).

According to the study, among physicians who already had "fully functional" EHR systems, 82% said the technology had improved the quality of medical decisions in their practices, 86% said they had averted prescription errors and 85% said that it had enhanced their delivery of preventive care to patients.

However, 54% of the respondents said that difficulty finding an EHR system that met their needs was a "major barrier" in their ability to adopt the technology (New York Times, 6/19).

The Times reports that many physicians "lack the financial incentive" to invest in EHR systems. Although private and government insurers can reduce costs through less paper, lower administration expenses and fewer unnecessary lab tests, the initial investment in EHR systems typically falls to the physicians, according to the Times.

In addition, the "time-consuming conversion" to an EHR system could reduce the number of patients a physician could see, "perhaps doubling the cost" (New York Times, 6/19).

Philadelphia-based physician Richard Baron, who in conjunction with the release of the study participated in a conference call sponsored by the Robert Wood Johnson Foundation and the Massachusetts General Hospital's Institute for Health Policy, said that setting up an EHR system was "the most difficult thing we have ever done in our practice."

Baron said, "It disrupted every system we had in the office" and "made us dependent on a tech we did not understand and could not maintain ourselves" (Goldstein, "Health Blog," Wall Street Journal, 6/18).

According to Baron, it cost each physician in his practice $40,000 to implement an EHR system and another $60,000 annually for technical support. Baron recommended financial incentives as a way to encourage a wider adoption of the technology. "I really think new financing strategies are desperately needed" (CQ HealthBeat, 6/18).

The study found that 42% of the physicians reported that they currently are setting up an EHR system or plan to do so in the next two years.

According to DesRoches, federal officials' announcement last week of a $150 million Medicare pilot program to assist hundreds of physicians in converting to an EHR system will encourage a widespread change in the U.S. health care system. "The physicians who now use these systems like them," DesRoches said (USA Today, 6/19).

Efforts to develop a national EHR system have received the support of President Bush and both the Republican and Democratic presidential candidates, according to Blumenthal and DesRoches. However, the authors note that widespread adoption of EHRs could cost tens or hundreds of billions of dollars, much of which would come through government incentives.

"[W]hether any future federal administration will find the resources is uncertain," they wrote ("Health Blog," Wall Street Journal, 6/18).

Karen Bell, director of the Office of Health IT Adoption at HHS, said she is "heartened" by the growing response among physicians to adopt EHR systems, noting, however, that the study shows "we are a long way from universal adoption" (USA Today, 6/19).