Infotech tipping point? (HIMSS meeting)
■ It seems that momentum and physician interest in electronic medical records are getting bigger than ever. But doctors at a major information technology conference don't know if the technology has really hit the mainstream.
By Tyler Chin — Posted March 14, 2005
Paul Tang, MD, an internist and chief medical officer of the 600-doctor Palo Alto (Calif.) Medical Foundation, stood up before a physician symposium at a major medical information technology conference to make a declaration.
"We're really near the tipping point" of adopting electronic medical records, he told the crowd on the first day of February's Healthcare Information and Management Systems Society Conference & Exhibition in Dallas. Rather than EMRs being a rarity in practice, he and other speakers said, they are reaching the critical mass necessary to make physicians use them.
But audience member Jonathan D. Leffert, MD, a solo endocrinologist in Dallas, was unmoved.
"I'm a solo physician in private practice. My big concern is how physicians like myself and others in small and medium practices can afford an EMR," Dr. Leffert said afterward. "[Dr. Tang] is from a practice that probably has several hundred physicians whose decision-making is very different than if you're in solo practice and have to pay it out of your pocket."
The comment underscores the disconnect between the physicians who generally pound the table for clinical automation and those who are supposed to feel their vibrations. The former typically are from deep-pocketed large practices while the latter are small and medium practices with little change to spare. But smaller practices are being heavily courted, because the goal of improving patient safety and reducing costs through automation can't happen without them.
The Chicago-based HIMSS, which historically has geared its annual conference toward senior management and technology executives at large hospitals, started reaching out to small practices in 2003.
This year, it drew more than 21,000 attendees, including 588 physicians, though not all of them are practicing or in private practice. The technology symposium attracted 250 attendees, up from 180 in 2004.
But the increased physician visibility at HIMSS does not mean doctors will buy an EMR anytime soon, even with President Bush pushing to have electronic medical records implemented nationwide within a decade. Although EMRs have been on the market for years, sales remain limited to a select group referred to as early adopters, who are estimated to be up to 15% of all physicians.
Recent studies have estimated that fewer than 10% of physicians use EMRs.
The conventional wisdom is that until powerful EMRs sell for $10,000 or less per physician, demonstrate that they save time and money, or are mandated, physician adoption of the technology will continue to just inch forward.
"The reality is that many people are very fearsome of computers, especially in medical offices," said Armand A. Gonzalzles, MD, a solo pediatrician in Chicago, whose practice was one of four small- and medium-size practices honored at the HIMSS conference for their implementation of EMRs.
Even physicians interested in using EMRs aren't necessarily ready to buy them.
Unless a hospital, insurance company or the federal government offers a $10,000 bonus or grant, Dr. Leffert says he's not buying. "EMRs are absolutely the right thing to do, but for me the barriers are cost, time and energy [EMRs impose on me when most of the benefit accrues to insurers]," he said. "They are not insignificant."
For Sally M. Knox, MD, a surgical oncologist in Dallas who also attended the HIMSS conference for the first time so she could research EMR products, the tipping point will come when the technology gets really good, which she believes is starting to happen. "If it saves doctors cost, if it saves them time, you won't be able to keep doctors away," she said. But systems costing $30,000 per physician are "not going to fly."
"It really comes down to economics more than anything else," said Robert J. Lamberts, MD, an internist and pediatrician at Evans (Ga.) Medical Group, a four-doctor primary care practice that has an EMR. "Nobody had to convince an ophthalmologist to do LASIK surgery; they all spent the money to learn to do that because there was a financial incentive. If there was the same financial incentive for [an EMR], it'd be a done deal."