Start-Up Costs Slow Shift To Electronic Medical Records

Adoption of electronic health records (EHR) continues to be slow and confined primarily to larger group practices.

Moreover, adoption by psychiatric medical groups appears to be very rare, according to a survey conducted by the Medical Group Management Association (MGMA) and the University of Minnesota School of Public Health, with funding from the federal Agency for Healthcare Research and Quality (AHRQ).

A report on the survey appears in the September Health Affairs.

Of 3,300 group practices that responded to the survey, just 14.1 percent indicated that they use an electronic health record system. A smaller percentage said they use a document image management system (DIMS) to create electronic files of scanned documents, or else a combination of dictation and transcription and DIMS. But by far the largest percentage (75.3 percent) still rely on paper medical records filed in cabinets.

David Gans, director of practice management resources for MGMA, told Psychiatric News that only 17 psychiatric medical group practices were included in the survey. But 15 of those 17 relied entirely on paper medical records; two practices used an image management system, but none had an EHR system, Gans said. (The breakdown by physician specialty was not included in the Health Affairs report.)

To conduct the survey, researchers drew on a national database of 34,490 group practices (defined as three or more physicians practicing together with a common billing and medical-record system). These 34,490 practices were placed into 16 sampling cells— four regions and four sizes of group practice —and from each cell half of the practices were randomly chosen for surveying.

The survey had three stages: (1) group practices with e-mail addresses were asked to complete a Web-based survey; (2) those that did not have an e-mail address or did not respond to the e-mail request were mailed a paper survey and asked to complete either the paper or the Web-based survey; (3) 750 nonresponding practices were surveyed by telephone.

Only 12.5 percent of responding medical group practices with five or fewer per fulltime-equivalent (FTE) physicians have adopted an EHR. The adoption rate increased with the size of practice; groups with six to 10 FTE physicians reported a 15.2 percent adoption rate, groups with 11 to 20 FTE physicians reported an 18.9 percent adoption rate, and groups of 20 or more FTE physicians had a 19.5 percent adoption rate.

Despite the low adoption rate, a significant number of practices are at least planning to implement electronic records. Of the groups that responded, 12.7 percent were in the process of implementing an EHR, 14.2 percent said implementation is planned in the next year, and 19.8 percent said implementation was planned in 13 to 24 months.

The remaining 41.8 percent said they have no immediate plans for EHR adoption. Within this group, the difference between large and small groups is striking—47.8 percent of practices with five or fewer FTE physicians had no EHR plans compared with only 20.2 percent of practices with 21 or more physicians.

“As far as adoption rates go, the needle has not moved significantly in the past year,” Jon White, M.D., health information portfolio manager at AHQR, told Psychiatric News. “And the adoption rate is so much greater among the larger groups. That is very telling about the state of products on the market and their characteristics.

“These systems cost money, and for large groups it can make some economic sense because they have significant information management issues. A lot of physicians, a lot of patients, a lot of information—in order to efficiently run your practice, you have to be able to manage that information efficiently.”

Is it still reasonable to aim for a national health information network within 10 years, as projected by President Bush a year and a half ago?“ It's possible,” White said. “A lot of work remains to be done, but I am optimistic.”

Survey respondents were also asked about barriers to adoption of EHR. The highest-rated barrier was lack of capital resources to invest in electronic records. Others included concerns about lost productivity during transition to electronic record keeping, inability to input historical medical record data easily, lack of support from practice physicians, and insufficient return on investment.

According to the survey, the average purchase and implementation cost of an EHR system was $32,606 per FTE physician. Maintenance costs were an additional $1,500 per physician per month. The study also found that the average cost for EHR implementation was about 25 percent more than initial vendor estimates.

An abstract of “Medical Groups' Adoption of Electronic Health Records and Information Systems” is posted at<http://content.healthaffairs.org/cgi/content/abstract/24/5/1323>.▪

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