Roadmap for health IT

If Congress wants to encourage greater electronic medical record adoption, it needs to address two major concerns.

One is providing the right incentives so that physicians in any size practice can make a business case for information technology. The other is making privacy and security a top priority to allay patients' concerns about who is seeing their information, and how it is being used. That way, health IT can fulfill the promise to serve both doctor and patient.

Physicians' use of EMRs, especially in smaller practices, is low, in part because of the high expense and small return in investment and system upkeep. As the AMA pointed out in a March 28 statement to the House Committee on Small Business Subcommittee on Regulations, Healthcare and Trade, the Congressional Research Service estimates that the per-physician startup cost for an EMR can range from $16,000 to $36,000. Then, a practice has to spend around $8,500 per year, per doctor, and on ongoing costs, such as software licensing and software and hardware upgrades, according to a study published in the September-October 2005 edition of Health Affairs.

The hearing was held as a fact-finding affair. No IT bill is expected to go through Congress in 2007 after competing House and Senate measures failed to find traction in the other's chamber last year.

Lawmakers -- and this also holds true for the AMA and many other physician organizations -- see great promise in the potential of health IT to raise the overall quality and safety of care. In addition, there appears to be general agreement that incentives are necessary to encourage widespread adoption, though no bill has completely addressed physicians' concerns.

For physicians, this point is essential, because they clearly are expected to bear much of cost burden. Yet as things stand, others will realize a much greater cost savings.

In its statement, the AMA estimates that for every $1 of cost savings attributed to health IT, physicians would see 11 cents, while 89 cents would go to those who typically do not pay for health IT directly, such as insurers, laboratories, patients, and private and government payers.

The AMA is encouraging Congress to consider economic incentives for physicians to adopt IT, such as grants, low-interest loans, increased reimbursement for IT use, accelerated depreciation for IT investments and tax credits.

Also, the AMA supports efforts to moderate Stark self-referral and anti-kickback laws so that physicians can work in partnership with others in the health care system to receive donated hardware, software and technology that primarily -- not exclusively -- can be used for the creation, maintenance and exchange of health care information. Also, the list of acceptable donations should include costs associated with maintenance and upgrades of equipment and software. These donations should not restrict choices on which IT system physicians would use, nor which information they would share with others.

It is that sharing of information that gives some patients pause when it comes to their doctors using health IT. Various studies show that about half of patients feel like the privacy risks of EMRs outweigh the quality benefits.

In its statement to the House subcommittee, the AMA points out that its own ethical policy and the physician licensing laws in every state demand that information disclosed in the patient-physician relationship is confidential to the greatest possible degree. But there is a growing consensus that privacy and security provisions under HIPAA might not be enough to ensure data protection.

With that in mind, Congress should make sure that any health IT legislation ensure that comprehensive privacy and confidentiality provisions are in place to protect patient information.

The pressure is building for legislators to do something to encourage technology adoption. But if health IT is to have the transformative power that physicians, patients and policymakers wish it would have, the issues of physician cost and patient information privacy must be satisfied.