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Small medical practices are slow to adopt health information technology

Health information technology (health IT) can help reduce medication errors, improve the quality of care, lower costs, and increase patient and clinician satisfaction. Yet, small practice settings, where 80 percent of physicians work and where most patient care is provided, have been slow to adopt health IT, according to two studies supported by the Agency for Healthcare Research and Quality (AHRQ). The first AHRQ-supported study (Contract No. 290-00-0017), found that the adoption of electronic health records (EHRs) by small medical group practices is happening slowly, but a number of them plan to implement an EHR within the next 2 years. The second AHRQ-supported study suggests that one problem hindering adoption of health IT is that small physician practices have complex workflows that are poorly addressed by standardized health IT systems.

Reprints of the second study (AHRQ Publication No. 06-R010) are available from the AHRQ Publications Clearinghouse. Both studies are discussed here.

Gans, D., Kralewski, J., Hammons, T., and Dowd, B. (2005, September). "Medical groups' adoption of electronic health records and information systems." Health Affairs 24(5), pp. 1323-1333.

Adoption of EHRs by small medical group practices is progressing slowly, although a number of group practices plan to implement an EHR within the next 2 years. Researchers found the barriers to group practices adopting an EHR system are greater than expected. Also, the process of choosing and implementing an EHR appears to be more complex and varied than was previously thought. Because of the large number of EHR systems available, it is not easy to identify which systems meet a practice's needs and which companies offering EHRs have adequate technical support. It is also especially difficult for small and physician-owned practices to meet the managerial challenges and capital costs of EHR systems, note the researchers.

Researchers assessed the rate and process of adoption of health IT and EHRs by medical group practices by analyzing 2005 data from a nationally representative survey of 34,490 medical groups (those with 3 or more physicians) and conducting a series of interviews and site visits to practices. Overall, 15 percent of practices surveyed had EHRs. About 12 percent of practices with 5 or fewer full-time-equivalent (FTE) physicians had EHRs compared to 19 percent of practices with more than 10 physicians, which probably have more financial resources and administrative capacity.

However, a substantial number of practices indicated that they were planning to adopt EHRs in the future. If their plans are fully carried out, about 60 percent of all practices will have adopted EHR technologies 2 years from now. However, nearly half of practices with five or fewer FTE physicians currently do not have EHRs and have no plans to implement them within the next 2 years.

Practices without EHRs cited costs and concern about physicians' support and ability to use the new system as chief barriers to their adoption. Interviews revealed that the majority of practices found the transition to EHRs difficult even if the physicians and nurses were supportive.

Lee, J., Cain, C., Young, S., and others (2005, September). "The adoption gap: Health information technology in small physician practices." Health Affairs 24(5), pp. 1364-1366.

Successful adoption of health IT requires close attention to office workflow—how tasks are organized and resources are used to achieve outcomes—concludes a panel of leading national experts. The panel of practitioners, consumer advocates, researchers, consultants, vendors, and policymakers was convened in April 2005 by the National Institute for Health Care Management (NIHCM) Foundation, at a conference supported by AHRQ, to gain insight into health IT adoption in small practices.

The panelists pointed out that small physician practices encompass diverse delivery systems with complex workflows that are poorly addressed by standardized health IT systems. Classification of practices by clinical specialization or size may need to expand to include such factors as the patient population served, dynamic reimbursement models, whether the practice belongs to a managed care plan, and staffing. Differences in small practices also make it difficult to develop standardized recommendations about optimal system design of health IT products and services.

The panelists agreed that well-integrated health IT has the potential to greatly improve patient care. Panelists who successfully made the leap to health IT described immediate and long-term gains for their clinicians, consumers, and the public health system. In the short term, patients and clinicians appreciated the greater flexibility and efficiency in scheduling, communication, prescribing, disease management, chart review, and education. Practices that redesigned their workflows discovered fewer interruptions, a better ability to deliver comprehensive care, including preventive services, and improved ability to address patient concerns.

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