For most family-practice doctors, swallowing the $25,000 or more needed to adopt electronic records has been too bitter a pill. So the American Academy of Family Physicians is sweetening the incentive, hoping to get tens of thousands on electronic systems by 2005.
The AAFP--the largest professional organization for family physicians, with 55,000 active members--said this week it has negotiated discounts of 15% to 50% from makers of software and other gear needed to create electronic health records in their practices. It's one of the medical industry's biggest pushes yet to get doctors to adopt electronic health records.
"The No. 1 reasons why doctors say they've looked into [electronic health records] and decided not to deploy it is the expense," says Dr. Michael Fleming, president of AAFP and a practicing family physician in Shreveport, La. Fleming has been quoted estimates for his 10-doctor physician group of $200,000 to $600,000 for software, hardware, and services needed to implement electronic records. Typically, electronic-record systems cost $25,000 to $50,000 per practice, excluding hardware, according to the AAFP.
The vendors in the program include A4 Health Systems, a provider of health-records and practice-management software; GE Medical Systems Information Technologies, a provider of ambulatory electronic records systems; Hewlett-Packard; and Siemens, a provider of medical gear and hosting services. Other participants include MedPlus, a subsidiary of Quest Diagnostic, which provides laboratory services to doctors and hospitals. MedPlus could provide the interfaces needed for electronic lab orders and test results to be sent between doctor offices and Quest labs.
In 1999, the AAFP set a goal of having at least 50% of its members adopt electronic records by 2005. Less than 10% of AAFP members have done so. But there's been progress--95% of the members now use E-mail, says AAFP executive VP Dr. Douglas Henley.
Pressure to adopt electronic records doesn't only come from AAFP. The business-sponsored health-care watchdog group LeapFrog considers electronic records in rating health-care providers because it believes it helps improve efficiency and quality. And the U.S. Health and Human Services Department advocates that doctors and hospitals adopt electronic records because they have potential to reduce medical errors, improve collaboration, and reduce the costs associated with manual processes and duplicated medical services that result when access to patient information is hampered by paper files.
Besides discounts, vendors are promising financing so doctors can spread the cost over three to five years. "Many practices, particularly the smaller ones, can't afford to make huge investments, especially all at once," says Larry Stofko, VP of IT strategy at St. Joseph Health System, which operates 15 hospitals in California and Texas and a 125-physician practice group.
Yet cutting the cost won't be enough to sway many doctors. Deterrents include the lack of interoperability among different electronic-record systems, as well as integration problems among the record systems and doctors' practice-management systems. Also, there's a lack of standards, such as a national patient ID system to ensure that clinical information sent electronically belongs to the correct patient. However, Fleming says vendors participating in the AAFP program have agreed to develop interfaces that allow records and practice-management systems to communicate, as well as meet de facto standards that the federal government supports.