Resistance To EHRs May Widen Healthcare Disparities

As the push to implement new health information technology (HIT) among healthcare providers continues, many small physician practices offering services to Medicaid patients have shown a reluctance to adopt HIT, such as electronic health records (EHRs).

If these medical practices continue to resist implementing modern HIT systems, the situation threatens to widen healthcare disparities in the coming years, said Dianne Hasselman, director of quality and equality at the Center for Health Care Strategies (CHCS), at a recent public hearing on how technology can improve healthcare delivery among low-income populations.

Hasselman's gloomy assessment was delivered earlier this month when she offered her thoughts as part of a panel convened by the HIT Policy Committee's Meaningful Use Workgroup to discuss using HIT to eliminate disparities.

"Medicaid programs have been striving to actively engage small, high-volume practices in HIT adoption and practice transformation. These efforts have been very challenging for all parties with limited results to date," Hasselman said.

Modernizing the healthcare information technology infrastructure is a key element of President Obama's health reform program. To help facilitate this vision, the Health Information Technology for Economic and Clinical Health (HITECH) Act established programs under the Centers for Medicare & Medicaid Services to provide incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. The programs begin in 2011, and are an essential part of the federal government's goal to provide every citizen with an EHR by 2014.

Hasselman's work with CHCS, a Hamilton, N.J.-based nonprofit health policy resource center dedicated to improving healthcare quality for low-income children and adults, led her to meet with solo practitioners in Oklahoma City, Detroit, and Philadelphia. She noted that while these physicians truly want to improve care for their communities, they are extremely reluctant to adopt HIT. Neil Calman, president of the Institute for Family Health, wanted to know what the likelihood is of small practices either joining larger physician practices or closing their doors if they didn't adopt new technology. He also asked the panel how these practices will be monitored for HIT adoption and, if they are not supervised, what impact will that have on care for low-income populations.

"I don't know if we have an answer for that at this point," Hasselman said. She noted that many small practices don’t have computers and are struggling to provide basic healthcare services. Doctors at these practices are saying, "hey, don't even talk to me about HIT now. Help me with practice management, help me just to keep my shingle out, and then I can take a breath and get some breathing space and focus more on HIT or quality improvement," Hasselman said.

While these practices are small, they serve a large swath of the population, including large clusters of patients with diverse ethnic and racial backgrounds. For example, Michigan’s Medicaid data shows that approximately 50% of beneficiaries in Detroit receive care in practices of three or fewer providers.

"In many states and regions these small practices serve the majority of Medicaid beneficiaries, and they are under-resourced and disenfranchised from the larger integrated systems, and from quality improvement activities," Hasselman told the panel.

She also said small, high-volume Medicaid practices will be left behind if they're not either successfully engaged to participate in the incentive program or if Regional Extension Centers are unable to join with small practices as they develop new technological capabilities. "That would contribute to even greater disparities in health outcomes," Hasselman predicts.

Currently, several state Medicaid agencies and regional quality improvement alliances are exploring viable, effective, and sustainable solutions to support small Medicaid practices. Hasselman said these are encouraging signs, but stressed that more needs to be known about the size and type of these small practices and their resource needs.