Left Behind

Edition: March 2007 - Vol 15 Number 03
Article#: 2632
Author: Repertoire

Large physician groups are outpacing their smaller counterparts in terms of implementing information technology, according to a recent study. Surprisingly, physician groups serving higher numbers of underserved or low-income patients are just as likely as other groups to implement information technology in their offices.

The study, Clinical Information Technology Gaps Persist Among Physicians, was published recently by the Center for Studying Health System Change, a Washington, D.C.-based policy research organization, funded principally by The Robert Wood Johnson Foundation. It compares data from a 2004 to 2005 survey of 6,600 physicians to a 2000 to 2001 survey of 12,000 physicians. The study examined IT implementation in the following five clinical areas:

• Obtaining treatment guidelines

• Exchanging clinical data with other physicians

• Accessing patient notes

• Generating preventive care reminders

• Writing prescriptions.

Smaller groups fall behind

Across all practice settings, implementation of information technology for each of the five clinical activities increased between 2000 to 2001 and 2004 to 2005.

However, adoption gaps between small and large practices persisted for two of the clinical activities (obtaining treatment guidelines and exchanging clinical data with other physicians) and widened for the other three (accessing patient notes, generating preventive care reminders and writing prescriptions).

“Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices — which account for more than half of all practicing physicians — appear to be at risk of being left behind,” said Joy M. Grossman, Ph.D., co-author of the study and senior health researcher at the Center for Studying Health System Change. “The differences may reflect a natural path of technology adoption where larger, savvier organizations adopt new technologies first and others follow, albeit at a slower rate, or it may be that smaller practices face different and substantial barriers that affect how quickly they catch up, if ever.”

Regarding electronic prescription-writing, the adoption gap between small group practices (those with one to nine physicians) and large ones (those with 51 physicians or more) tripled between 2000 to 2001 and 2004 to 2005.

In 2000 to 2001, 8 percent of physicians in small group practices reported access to IT to write prescriptions, with the percentage growing to 13 percent in 2004 to 2005. In contrast, 19 percent of physicians in large group practices reported access to IT to write prescriptions in 2000 to 2001, but the percentage grew to 47 percent by 2004 to 2005.

Some of the differences in adoption gaps may be explained by larger practices’ access to money and expertise, according to the study’s authors. This appears to be true for implementing electronic medical records, which allow physicians access to patient notes. But the relatively flatter rates of adoption among physicians in most practice settings for other clinical activities — such as preventive reminders for patients —may reflect that these adoption decisions are influenced by factors beyond cost. For example, preventive reminders may be a more clinically appropriate tool for some specialties than others, resulting in lower adoption across all practice sizes.

Practices serving the underserved

Somewhat surprisingly, the study found that physicians in practices treating more underserved and vulnerable patients — low-income, minority or rural patients and those with chronic conditions — generally were just as likely to report access to information technology in their practices as other physicians.

For example, physicians in practices with the highest proportion of Medicaid revenue — greater than 25 percent of total practice revenue — were as likely or more likely as other physicians to report IT for each of the clinical activities, regardless of practice size. Similarly, physicians in practices with the highest proportion of patients with chronic conditions and minority patients were as likely or more likely to report having access to IT for all five clinical activities from 2004 to 2005.

Even so, access to information technology was lower than average for physicians practicing in community health centers for two of the five clinical activities — exchanging clinical data and accessing patient notes. This statistic likely reflects the importance of financial barriers to IT adoption for these two clinical activities, according to the authors.

Because the study measured access to information technology and not actual usage, the numbers may overstate the percentage of physicians actually using the various technologies, according to the study’s authors.

They also questioned whether small groups — in which most physicians work — would ever catch up with their larger counterparts. “Many public and private efforts are underway to help speed adoption of IT in the ambulatory setting,” they wrote. “However, right now activities specifically targeted at small practices or the safety net are not widespread.”

What are your doctors thinking?

For electronic medical record systems to enjoy widespread implementation, policymakers and others have to consider the concerns that doctors have about them. The following are findings for policymakers to consider. How many are on your physician customers’ minds?

Four factors drive [electronic health record] adoption: financial incentives and barriers, laws and regulations, the state of the technology, and organization influences.

Financial barriers include the high cost of EHR systems and providers’ uncertainty about the return on investment. Providers still question the business case for EHR adoption.

Legal barriers to adoption include concerns about newly created potential legal liabilities and concern over the actual or perceived legal burden of compliance with regulations regarding privacy and other factors.

The technology-related barriers include concern about ease of use and obsolescence of particular EHRs.

Organizational barriers can include small size of practice or hospital, payer mix, level of integration of the care system, and organizational leadership.

Source: “Health Information Technology in the United States: The Information Base for Progress,” by The Robert Wood Johnson Foundation, George Washington University Medical Center, Institute for Health Policy.