Obama's Health IT Push: Physicians Don't Know Much About It

A growing number of physicians in practices of 10 or fewer doctors are planning to acquire an electronic health record, or EHR, according to a new survey. But it doesn't appear that most practices will do so anytime soon, and half of those who are in the market don't have any idea what they have to do with their future EHRs to get government subsidies.

In other words, the government still hasn't managed to get the word out to the bulk of practicing physicians -- and should push back some of its deadlines as a result.

Seventeen percent of the respondents to an online survey by NaviNet say they plan to implement an EHR by the end of 2011. But that still leaves 83 percent who have no immediate plans to get an EHR. More of them probably will buy one down the line, however, since only 21 percent said they had decided not to purchase a system.

The lack of urgency underlines the fact that many physicians have little knowledge about the "meaningful use" requirements for obtaining government subsidies. (For the uninitiated, this means showing that an EHR is being used to increase the quality and efficiency of care.) To the extent that government policies are having an impact on this population, which includes the majority of doctors, they're concerned about losing a small portion of their Medicare reimbursement if they're not using EHRs by 2015. But many don't know what they have to do to prevent that from happening, according to the NaviNet poll.

A recent Accenture survey of small and medium-sized practices paints a rosier picture: 60 percent of physicians surveyed said they planned to get an EHR in the next two years, and 80 percent of those 55 or under did. But Kip Webb, who leads Accenture's clinical transformation practice, told Information Week that he doesn't expect the government to meet its goal of having universal electronic health records by 2014. Actually, considering that only 6 percent of physicians have fully functioning EHRs today, it would be a miracle if that occurred.

Here's where the government health IT program stands right now:

• Most doctors don't know much about it;
• The majority will not have EHRs in time to qualify for the full subsidies;
• Physician and hospital groups say the meaningful use criteria are too stiff for most providers to comply with them;
• Until the criteria are finalized, probably at the end of June, vendors can't build into their software the tools doctors will need;
• The government has just announced contracts for the technology extension centers that are supposed to help small practices implement EHRs;
• There's a lack of trained technical personnel to staff these centers.

The health IT program won't be a failure: Some physicians and hospitals will receive essential financial and technical aid. The money that's flowing to states to help build the infrastructure for health information exchanges will improve the ability of providers who have EHRs to access key patient data. But barring an unforeseen breakthrough on all of the fronts listed above, far fewer providers will hop aboard the health IT train than proponents envisioned when the stimulus legislation was passed last year.

What can be done? For one thing, the Department of Health and Human Services can pay close attention to a letter from a bipartisan group of 27 U.S. Senators that urged some revisions in the meaningful use rules as well as a delay in the quality reporting requirements. Also, the government could consider postponing the start of the period for showing meaningful use -- as well as the awarding of subsidies. Setting that deadline back for a year would give vendors more time to incorporate the necessary features, for HHS to educate physicians, and for physicians to implement and learn how to use their EHRs.

As Duke Ellington's song went, "It don't mean a thing if it ain't got that swing."