The cost, physician practice size, and lack of technical resources still present barriers for small healthcare providers in adopting electronic health records and participating in the meaningful use incentive program.

Solo practitioners and small practices find it difficult to locate a lender willing to offer them an unsecured loan, said Sasha Kramer, MD, a solo practitioner dermatologist in Olympia, Wash. Others who try to finance their electronic health record system with the vendor have no leverage in negotiating terms because of their limited market share.

Kramer was among public and private health IT experts and physicians who spoke at a June 2 hearing of the House Small Business Committee’s health care and technology subcommittee.

Two years ago, Kramer purchased and deployed an EHR system that cost more than $41,000. It took four weeks to learn and integrate. Although quick by many standards, it reduced the number of patients she saw by 75 percent, from 4 per hour to 1 per hour, and slashed her revenues, she explained.

[Editor's Desk: This Week in Government Health IT.]

Two years later, she has to replace that EHR because her vendor was acquired and no longer supports her system. “I have to invest $30,000 in a new system and take time again from my patients to learn it,” she said. 

“Despite these factors, I fully support the infusion of health IT into physician practices. It is a critical component in improving the healthcare delivery system and, more importantly, providing optimal patient safety and care,” Kramer said.

For instance, she has each patient’s chart and information for each visit and can track drug interactions and medication refills and past medical history. “It is much easier to communicate with other providers, and I am able to operate more efficiently with less employee time spent pulling and organizing charts,” she said.

Farzad Mostashari, MD, national coordinator for health IT, is familiar with the difficulties of solo physicians and small practices acquiring and deploying health IT. Before coming to the Office of the National Coordinator for Health IT (ONC) in 2009, he led the New York Primary Care Information Project where in three of the city’s most underserved communities in one year’s time more than 1,000 providers went live with EHR systems.

ONC has funded 62 regional health IT extension centers nationwide that are now assisting more than 70,000 mostly primary care physicians with EHR purchase, implementation, project management and other technical challenges of establishing and becoming meaningful users of certified EHRs. ONC also lists more than 700 certified EHR products on its website.

“I make no bones about the transformation of workflows and processes and the difficulties that many practices, especially smaller practices, will face as they make this difficult transition. But it is a rewarding process and ultimately will not only lead to improved patient care and coordinated care but will help those practices succeed financially over the long run,” Mostashari said.

Kramer urged Congress to provide sufficient financial resources so solo physicians can establish health IT and to consider delaying the penalties that take effect in several years for those who do not become meaningful users until such time that a functional integrated EHR system is widely available. She also said that some physicians should be exempted from financial penalties so that they are not pushed into early retirement, which could further exacerbate the physician shortage. 

[Interview: CMS' Jessica Kahn on early EHR, HIE lessons learned.]

Andrew Slavitt, CEO of OptumInsight, a health IT services company, said that the temporary financial incentives will not be enough to compensate for provider productivity losses. Meaningful use is just a starting point for private sector innovation revving up.

Capabilities that enhance provider productivity are not driving the purchase and design of EHR technology.
“New product development is focused on satisfying the regulatory hurdles of the payer, CMS, rather than simple innovations that improve productivity,” Slavitt said. 

Slavitt suggested that federal policymakers align the requirements that physicians are subject to among multiple programs. He also urged continued federal investment in health information exchanges and the extension centers, which have proven to be a strong tool to provide expertise for small practices. The Small Business Administration should also supply business loans to small providers.