Why Doctors Still Don't Use Electronic Medical Records, Part XXI: Terrible Tech Support

Despite generous financial incentives from the government, small physician practices continue to resist the gospel of health information technology.

One reason is that most small practices lack the resources and the technical knowledge to implement these complex systems. Software companies offer training and support, but it's often inadequate for doctors who aren't computer-savvy. Moreover, hardware and software vendors don't have the "boots on the street" to ramp up the thousands of physicians who are expected to vie for the federal subsidies that will be handed out next year.

To address this problem, the federal government is creating health IT regional extension centers, or HITRECs, to help small primary-care practices choose and implement electronic medical records. These are roughly analogous to USDA's agricultural extension service, which was created a century ago to spread modern farming techniques to the nation's scattered small farmers.

The government has allocated nearly $600 million for this purpose, and the Office of the National Coordinator for Health IT will award 60 HITREC grants by the end of March. But specialized technicians are still in short supply, and it will take a while to get these extension centers up and running.

Some large healthcare systems, motivated by competitive concerns and the desire to meet "meaningful use" criteria for federal incentives, are also trying to help their physicians computerize. But this has proved more difficult than many expected, because of the magnitude of the effort required to install digital records in small practices.

One company that sees a market opportunity in this area is Dell Perot Systems Healthcare Services, which is working with hospitals to accelerate the rollout of digital record systems to their affiliated physicians. For example, one large southwestern healthcare system has been subsidizing electronic health records for staff physicians for the past year and a half. But to date, only about 100 practices have implemented them because the organization's IT staff has been unable to keep up with the demand, according to Jamie Coffin, vice president of Dell Healthcare and Life Sciences.

Dell Perot has stepped into the gap, offering the system's affiliated physicians access to and help installing digital-record systems from eClinicalWorks, NextGen and Allscripts. The company will host all three programs on its remote servers -- a "cloud-based" method of delivering software and data over the Web that reduces the upfront cost for practices.

Dell Perot has also struck a deal with the American Medical Association to support AMA members who want to install electronic medical-record systems. The AMA is planning to launch a web portal that will give physicians the ability to prescribe and order lab tests electronically, along with access to electronic patient records. Dell Perot will host the initial record system from Ingenix (a UnitedHealth Group subsidiary) and will help physicians implement the software and computer systems. Pricing has not yet been worked out, Coffin says, but economies of scale should keep it fairly low.

That still begs the question of how Dell Perot can provide the same kind of consulting services to small practices that large groups and hospital systems pay big bucks for. Coffin notes that Dell has had a lot of experience in computerizing small businesses. Both Dell and Perot, before and after their merger, have also worked with many hospitals, including most of the 2,000 facilities that use Meditech information systems. The trick to bringing small practices up to speed, Coffin suggests, is to "get into the practice with a brief touch when we implement the EHR [electronic health record] and offer them online training after that."

Coffin claims that that has worked for physicians in big healthcare systems like Memorial Hermann. What remains to be seen is whether it will succeed in small, unaffiliated practices that need a lot of hands-on assistance in change management--the hardest part of the process.

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